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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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1309348.11,"10th_percentile":1309348.11,"90th_percentile":1309348.11,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":396879.73,"10th_percentile":396879.73,"90th_percentile":396879.73,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":197677.65,"10th_percentile":10599.32,"90th_percentile":200872.56,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":606290.6,"10th_percentile":606290.6,"90th_percentile":606290.6,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":202052.01,"10th_percentile":14676.7,"90th_percentile":207826.85,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":130045.47,"10th_percentile":130045.47,"90th_percentile":130045.47},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":100000.0,"10th_percentile":100000.0,"90th_percentile":100000.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":10599.32,"10th_percentile":10599.32,"90th_percentile":205070.12,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"11","median_amount":14676.7,"10th_percentile":10599.32,"90th_percentile":202741.46,"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."}]}]},{"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":90556.82,"maximum":255475.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":188358.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":92367.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":143675.89},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":203752.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":107807.45,"10th_percentile":107807.45,"90th_percentile":107807.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":746637.22,"10th_percentile":746637.22,"90th_percentile":746637.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"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":110561.79,"maximum":312279.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":229968.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":112773.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":175621.9},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":248764.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":348497.44,"10th_percentile":348497.44,"90th_percentile":348497.44,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":74217.92,"10th_percentile":74217.92,"90th_percentile":74217.92,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":262519.88,"10th_percentile":262519.88,"90th_percentile":262519.88,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":61365.62,"10th_percentile":61365.62,"90th_percentile":61365.62,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":82447.97,"maximum":232450.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":171491.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":84096.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":130726.83},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":185507.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":37401.86,"maximum":104541.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":77795.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38149.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":58792.52},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":84154.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":103406.5,"maximum":291962.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":215085.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":105474.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":164195.59},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":232664.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":343445.45,"maximum":973556.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":714366.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":350314.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":547514.72},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":772752.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simultaneous Pancreas And Kidney Transplant With Hemodialysis","code_information":[{"code":"019","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":57232.15,"maximum":160849.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":119042.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58376.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":90459.59},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":128772.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":136841.63},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":103358.95},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":103358.95},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":136841.63},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57232.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":117556.8},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":160849.56},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58376.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57804.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57804.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":133202.27},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":57232.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":139124.7},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":100212.59},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":139124.7},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57804.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60093.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59521.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57804.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":63061.51,"maximum":177402.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":131167.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64322.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":99768.52},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":141888.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":150923.58},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":113995.31},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":113995.31},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":150923.58},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63061.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":129654.22},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":177402.1},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64322.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63692.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63692.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":109326.2,"10th_percentile":109326.2,"90th_percentile":109326.2,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":3033.28,"10th_percentile":3033.28,"90th_percentile":3033.28,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":215457.91,"10th_percentile":215457.91,"90th_percentile":215457.91,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":58847.72,"10th_percentile":58847.72,"90th_percentile":58847.72,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":59459.98,"10th_percentile":59459.98,"90th_percentile":59459.98,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":59034.79,"10th_percentile":59034.79,"90th_percentile":59034.79,"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."}]}]},{"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":42616.68,"maximum":119348.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":88642.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43469.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":67120.09},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":95887.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":85272.58,"10th_percentile":85272.58,"90th_percentile":85272.58,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":181086.5,"10th_percentile":181086.5,"90th_percentile":181086.5},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":25813.02,"maximum":71634.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":53691.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26329.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":40286.25},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":58079.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":60942.53},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":46030.99},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":46030.99},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":60942.53},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25813.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":52354.02},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":71634.48},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26329.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26071.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26071.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":59321.74},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":25813.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":61959.3},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44629.76},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":61959.3},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26071.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27103.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26845.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26071.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":25750.76,"10th_percentile":25750.76,"90th_percentile":25750.76,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":46082.38,"maximum":129189.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":95851.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47004.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":72654.47},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":103685.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":109907.15},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":83014.86},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":83014.86},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":109907.15},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46082.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":94418.15},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":129189.61},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47004.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46543.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46543.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":85234.19,"10th_percentile":85234.19,"90th_percentile":85234.19,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":78639.1,"10th_percentile":78639.1,"90th_percentile":78639.1,"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":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":38863.61,"10th_percentile":2146.75,"90th_percentile":40063.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":142890.04,"10th_percentile":142890.04,"90th_percentile":142890.04,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":3001.07,"10th_percentile":2146.75,"90th_percentile":41240.86,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":111249.45,"10th_percentile":111249.45,"90th_percentile":111249.45,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4176.0,"10th_percentile":4176.0,"90th_percentile":4176.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":3001.07,"10th_percentile":1955.69,"90th_percentile":39813.53,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"12","median_amount":26491.1,"10th_percentile":2102.74,"90th_percentile":41340.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"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":31644.75,"maximum":88193.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":65821.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32277.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":49598.98},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":71200.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":47152.63,"10th_percentile":47152.63,"90th_percentile":47152.63,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":27265.44,"10th_percentile":27265.44,"90th_percentile":27265.44,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":53596.67,"10th_percentile":53596.67,"90th_percentile":53596.67,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":42561.8,"10th_percentile":42561.8,"90th_percentile":42561.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":27413.61,"10th_percentile":1537.33,"90th_percentile":28055.77,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":36684.9,"maximum":102505.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":76304.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37418.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":57647.61},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":82541.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":34405.92,"10th_percentile":34405.92,"90th_percentile":34405.92,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":10181.54,"10th_percentile":10181.54,"90th_percentile":10181.54,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":31256.03,"10th_percentile":1808.5,"90th_percentile":32526.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures With Cc","code_information":[{"code":"026","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25271.53,"maximum":70096.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52564.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25776.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":39421.55},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":56860.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_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":1150.9,"10th_percentile":1150.9,"90th_percentile":1150.9,"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":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1163.13,"10th_percentile":1150.9,"90th_percentile":23628.19,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":22132.7,"10th_percentile":21241.76,"90th_percentile":22366.08,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1628.35,"10th_percentile":1628.35,"90th_percentile":22340.6,"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."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc","code_information":[{"code":"027","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20616.46,"maximum":56878.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42882.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21028.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":31987.85},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":46387.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38087.7,"10th_percentile":38087.7,"90th_percentile":38087.7,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":47277.99,"10th_percentile":47277.99,"90th_percentile":47277.99},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"1 through 10","median_amount":40764.61,"10th_percentile":40764.61,"90th_percentile":40764.61},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1172.21,"10th_percentile":1172.21,"90th_percentile":1172.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33490.51,"10th_percentile":33490.51,"90th_percentile":33490.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":928.6,"10th_percentile":928.6,"90th_percentile":928.6,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":48289.62,"maximum":135457.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":100442.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49255.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":76179.24},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":108651.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":115239.19},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":87042.24},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":87042.24},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":115239.19},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48289.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":98998.76},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":135457.12},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49255.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48772.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48772.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":112174.36},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":48289.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":117161.85},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":84392.58},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":117161.85},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48772.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50704.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50221.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48772.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":42410.85,"10th_percentile":42410.85,"90th_percentile":42410.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":39292.3,"10th_percentile":39292.3,"90th_percentile":39292.3,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":27672.5,"maximum":76914.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":57558.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28225.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":43255.68},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62263.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":63694.23},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":27672.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":66526.2},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":47919.33},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":66526.2},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27949.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29056.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28779.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27949.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":52006.22,"10th_percentile":52006.22,"90th_percentile":52006.22,"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":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":6360.0,"10th_percentile":6360.0,"90th_percentile":26191.5,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":22602.14,"10th_percentile":22602.14,"90th_percentile":22602.14,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":24472.51,"10th_percentile":24472.51,"90th_percentile":24472.51,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":61048.3,"10th_percentile":61048.3,"90th_percentile":61048.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1653.61,"10th_percentile":1653.61,"90th_percentile":1653.61,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":18014.6,"maximum":49490.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37470.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18374.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":27832.94},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40532.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":39246.14,"10th_percentile":39246.14,"90th_percentile":39246.14,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":837.38,"10th_percentile":837.38,"90th_percentile":16387.55,"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."}]}]},{"description":"Ventricular Shunt Procedures With Mcc","code_information":[{"code":"031","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36159.29,"maximum":101012.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":75211.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36882.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":56808.26},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":81358.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":85935.99},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":64909.0},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":64909.0},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":85935.99},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36159.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":73825.2},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":101012.87},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36882.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36520.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36520.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":83650.49},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":36159.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":87369.75},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62933.1},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":87369.75},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36520.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37967.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37605.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36520.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":17504.87,"maximum":48043.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36410.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17854.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":27018.95},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39385.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":39785.56},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":17504.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":41554.5},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29932.03},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":41554.5},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17679.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18380.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18205.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17679.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":16559.09,"10th_percentile":1116.05,"90th_percentile":18428.55,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1116.05,"10th_percentile":1116.05,"90th_percentile":16341.63,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":11644.9,"10th_percentile":11644.9,"90th_percentile":11644.9,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":13788.28,"maximum":37490.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28679.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14064.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":21083.91},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31023.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":12686.53,"10th_percentile":12686.53,"90th_percentile":12686.53,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24412.65,"10th_percentile":24412.65,"90th_percentile":24412.65,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":11822.72,"10th_percentile":11822.72,"90th_percentile":11822.72,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":870.9,"10th_percentile":870.9,"90th_percentile":11734.99,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":31317.64,"maximum":87264.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":65140.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31943.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":49076.61},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":70464.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":74240.03},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":56074.83},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":56074.83},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":74240.03},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31317.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":63777.52},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":87264.93},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31943.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31630.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31630.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":72265.58},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":31317.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":75478.65},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":54367.85},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":75478.65},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31630.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32883.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32570.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31630.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":28031.89,"10th_percentile":28031.89,"90th_percentile":28031.89,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":19565.24,"maximum":53893.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40695.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19956.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":30309.15},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44021.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":45849.79},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34631.17},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":34631.17},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":45849.79},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19565.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":39388.27},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":53893.82},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19956.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19760.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19760.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":44630.4},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":19565.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":46614.75},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33576.96},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":46614.75},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19760.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20543.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20347.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19760.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27796.31,"10th_percentile":27796.31,"90th_percentile":27796.31,"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":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35662.04,"10th_percentile":35662.04,"90th_percentile":35662.04,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":16686.77,"10th_percentile":16686.77,"90th_percentile":16686.77,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":919.88,"10th_percentile":919.88,"90th_percentile":919.88,"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."}]}]},{"description":"Carotid Artery Stent Procedures Without Cc/Mcc","code_information":[{"code":"036","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16010.61,"maximum":43800.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33302.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16330.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":24632.76},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36023.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":689.77,"10th_percentile":689.77,"90th_percentile":12752.29,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":65235.7,"10th_percentile":65235.7,"90th_percentile":65235.7},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":13395.46,"10th_percentile":13395.46,"90th_percentile":13395.46,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":13875.05,"10th_percentile":13875.05,"90th_percentile":13875.05,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":13564.05,"10th_percentile":13564.05,"90th_percentile":13564.05,"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":"Extracranial Procedures With Mcc","code_information":[{"code":"037","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26723.7,"maximum":74220.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":55585.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27258.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":41740.54},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":60128.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":63142.48},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":47692.65},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":47692.65},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":63142.48},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26723.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":54243.93},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":74220.39},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27258.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26990.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26990.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":61463.18},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":26723.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":64195.95},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":46240.84},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":64195.95},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26990.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28059.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27792.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26990.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":24239.85,"10th_percentile":24239.85,"90th_percentile":24239.85,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":47106.21,"10th_percentile":47106.21,"90th_percentile":47106.21,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":13468.31,"maximum":36581.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28014.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13737.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":20572.95},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30303.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":54264.46,"10th_percentile":54264.46,"90th_percentile":54264.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":11894.52,"10th_percentile":11894.52,"90th_percentile":11894.52,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25260.35,"10th_percentile":25260.35,"90th_percentile":44776.98,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":33611.06,"10th_percentile":33611.06,"90th_percentile":33611.06},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":8551.79,"10th_percentile":849.79,"90th_percentile":12895.02,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29304.71,"10th_percentile":29304.71,"90th_percentile":29304.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20357.67,"10th_percentile":20357.67,"90th_percentile":20357.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":11854.27,"10th_percentile":11854.27,"90th_percentile":11854.27,"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":"Extracranial Procedures Without Cc/Mcc","code_information":[{"code":"039","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9918.45,"maximum":26501.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20630.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10116.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14904.16},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22316.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":22546.09},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17029.47},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":17029.47},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":22546.09},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9918.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":19368.71},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":26501.65},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10116.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10017.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10017.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21946.47},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":9918.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22922.25},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16511.07},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":22922.25},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10017.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10414.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10315.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10017.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"17","median_amount":8574.92,"10th_percentile":428.29,"90th_percentile":9396.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15688.95,"10th_percentile":15688.95,"90th_percentile":15688.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":7749.61,"10th_percentile":428.29,"90th_percentile":8521.46,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18912.12,"10th_percentile":17843.56,"90th_percentile":36407.93,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_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":460.27,"10th_percentile":460.27,"90th_percentile":460.27,"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":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"25","median_amount":615.64,"10th_percentile":428.29,"90th_percentile":8867.29,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20700.44,"10th_percentile":20700.44,"90th_percentile":20700.44,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11613.28,"10th_percentile":11613.28,"90th_percentile":11613.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":8492.11,"10th_percentile":8492.11,"90th_percentile":8492.11,"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."}]}]},{"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":31242.21,"maximum":87050.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":64983.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31867.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":48956.15},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":70294.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":74057.82},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":55937.2},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":55937.2},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":74057.82},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31242.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":63620.99},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":87050.75},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31867.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31554.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31554.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":72088.22},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":31242.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":75293.4},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":54234.42},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":75293.4},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31554.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32804.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32491.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31554.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":64120.66,"10th_percentile":64120.66,"90th_percentile":64120.66,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":163070.96,"10th_percentile":163070.96,"90th_percentile":163070.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":26168.8,"10th_percentile":1419.38,"90th_percentile":27445.86,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":18042.39,"maximum":49569.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37528.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18403.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":27877.32},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40595.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":42171.07},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31852.57},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":31852.57},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":42171.07},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18042.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":36227.98},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":49569.69},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18403.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18222.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18222.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":41049.51},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":18042.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":42874.65},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30882.94},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":42874.65},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18222.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18944.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18764.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18222.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":40205.64,"10th_percentile":40205.64,"90th_percentile":40205.64,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":16624.21,"10th_percentile":16624.21,"90th_percentile":16624.21,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":16632.43,"10th_percentile":16632.43,"90th_percentile":16632.43,"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."}]}]},{"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":14302.78,"maximum":38951.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29749.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14588.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":21905.51},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32181.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":33137.29},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25029.19},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":25029.19},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":33137.29},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14302.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":28467.31},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":38951.0},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14588.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14445.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14445.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":32255.99},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":14302.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":33690.15},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24267.27},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":33690.15},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14445.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15017.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14874.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14445.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":12458.71,"10th_percentile":12458.71,"90th_percentile":12458.71,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25765.95,"10th_percentile":25765.95,"90th_percentile":25765.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":14966.54,"maximum":40835.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31130.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15265.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22965.47},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33674.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":34740.73},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26240.3},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":26240.3},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":34740.73},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14966.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":29844.79},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":40835.76},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15265.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15116.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15116.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":33816.79},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":14966.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":35320.35},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25441.52},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":35320.35},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15116.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15714.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15565.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15116.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":14859.47,"10th_percentile":14859.47,"90th_percentile":14859.47,"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."}]}]},{"description":"Spinal Disorders And Injuries Without Cc/Mcc","code_information":[{"code":"053","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8359.88,"maximum":22076.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17388.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8527.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12415.28},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18809.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":18781.06},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14185.67},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":14185.67},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":18781.06},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8359.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":16134.28},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":22076.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8527.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8443.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8443.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18281.57},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":8359.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19094.4},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13753.84},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":19094.4},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8443.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8777.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8694.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8443.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":12708.48,"maximum":34423.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26433.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12962.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19359.57},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28594.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":29285.94},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22120.2},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":22120.2},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":29285.94},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12708.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":25158.73},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":34423.96},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12962.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12835.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12835.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":28507.07},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":12708.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29774.55},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21446.84},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":29774.55},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12835.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13343.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13216.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12835.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"18","median_amount":606.21,"10th_percentile":564.09,"90th_percentile":12546.46,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":67094.19,"10th_percentile":67094.19,"90th_percentile":67094.19},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24245.24,"10th_percentile":24245.24,"90th_percentile":24245.24,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20663.59,"10th_percentile":20663.59,"90th_percentile":20663.59,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20663.59,"10th_percentile":20663.59,"90th_percentile":20663.59,"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":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":11030.73,"10th_percentile":11030.73,"90th_percentile":11030.73,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36141.13,"10th_percentile":36141.13,"90th_percentile":36141.13,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"13","median_amount":5784.71,"10th_percentile":423.07,"90th_percentile":10575.91,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":606.21,"10th_percentile":606.21,"90th_percentile":11049.9,"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":"Nervous System Neoplasms Without Mcc","code_information":[{"code":"055","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8680.65,"maximum":22986.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18055.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8854.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12927.51},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19531.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":19555.93},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14770.95},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":14770.95},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":19555.93},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8680.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":16799.95},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":22986.88},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8854.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8767.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8767.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19035.83},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":8680.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19882.2},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14321.3},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":19882.2},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8767.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9114.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9027.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8767.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":16761.35,"10th_percentile":16761.35,"90th_percentile":16761.35,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":2922.0,"10th_percentile":2922.0,"90th_percentile":2922.0,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13831.52,"10th_percentile":13831.52,"90th_percentile":13831.52,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":533.98,"10th_percentile":533.98,"90th_percentile":8124.61,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19842.02,"10th_percentile":19842.02,"90th_percentile":19842.02,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":6527.09,"10th_percentile":410.53,"90th_percentile":8387.6,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":19030.1,"maximum":52374.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39582.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19410.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":29454.58},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42817.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":44557.06},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33654.75},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":33654.75},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":44557.06},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19030.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":38277.72},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":52374.29},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19410.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19220.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19220.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":43372.04},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":19030.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":45300.45},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32630.26},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":45300.45},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19220.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19981.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19791.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19220.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"12","median_amount":1216.66,"10th_percentile":942.26,"90th_percentile":18431.98,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"1 through 10","median_amount":22753.52,"10th_percentile":22753.52,"90th_percentile":22753.52},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":8980.41,"10th_percentile":8980.41,"90th_percentile":18166.79,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":137167.71,"10th_percentile":137167.71,"90th_percentile":137167.71},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1216.66,"10th_percentile":942.26,"90th_percentile":18375.64,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":126829.95,"10th_percentile":126829.95,"90th_percentile":126829.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30677.22,"10th_percentile":30677.22,"90th_percentile":30677.22,"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":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1216.66,"10th_percentile":471.13,"90th_percentile":17854.22,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":18408.06,"10th_percentile":18408.06,"90th_percentile":18409.46,"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."}]}]},{"description":"Degenerative Nervous System Disorders Without Mcc","code_information":[{"code":"057","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10872.02,"maximum":29209.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22613.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11089.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16426.91},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24462.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":24849.61},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18769.36},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":18769.36},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":24849.61},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10872.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":21347.6},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":29209.3},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11089.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10980.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10980.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20965.26,"10th_percentile":20965.26,"90th_percentile":20965.26,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":24266.63,"10th_percentile":24266.63,"90th_percentile":24266.63,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17749.44,"10th_percentile":17749.44,"90th_percentile":17749.44,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"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":7033.23,"10th_percentile":502.11,"90th_percentile":9922.44,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"13","median_amount":502.11,"10th_percentile":396.42,"90th_percentile":7985.0,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":5835.95,"10th_percentile":5835.95,"90th_percentile":5835.95,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":539.6,"10th_percentile":502.11,"90th_percentile":9891.13,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"1 through 10","median_amount":502.11,"10th_percentile":502.11,"90th_percentile":502.11,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":539.6,"10th_percentile":502.11,"90th_percentile":10000.04,"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."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia With Mcc","code_information":[{"code":"058","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14158.27,"maximum":38540.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29449.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14441.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":21674.75},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31856.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":32788.21},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24765.53},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":24765.53},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":32788.21},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14158.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":28167.43},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":38540.68},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14441.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14299.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14299.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":31916.19},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":14158.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":33335.25},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24011.64},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":33335.25},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14299.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14866.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14724.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14299.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":15728.51,"10th_percentile":15728.51,"90th_percentile":15728.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":13672.34,"10th_percentile":13672.34,"90th_percentile":13672.34,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":10437.71,"maximum":27976.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21710.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10646.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15733.37},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23484.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":23800.46},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17976.92},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":17976.92},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":23800.46},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10437.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":20446.31},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":27976.09},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10646.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10542.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10542.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23167.48},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":10437.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":24197.55},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17429.68},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":24197.55},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10542.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10959.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10855.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10542.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19182.38,"10th_percentile":19182.38,"90th_percentile":19182.38,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":7888.26,"maximum":20736.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16407.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8046.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11662.14},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17748.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17172.57},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":7888.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17936.1},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12919.51},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":17936.1},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7967.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8282.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8203.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7967.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":14160.1,"10th_percentile":14160.1,"90th_percentile":14160.1,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11314.74,"10th_percentile":11314.74,"90th_percentile":11314.74,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":18282.76,"10th_percentile":18282.76,"90th_percentile":18282.76,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":6073.45,"10th_percentile":6073.45,"90th_percentile":6073.45,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38185.21,"10th_percentile":38185.21,"90th_percentile":38185.21,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":132244.25,"10th_percentile":132244.25,"90th_percentile":132244.25},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":2800.0,"10th_percentile":1093.2,"90th_percentile":19812.46,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1895.24,"10th_percentile":1895.24,"90th_percentile":1895.24,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":19637.35,"10th_percentile":19637.35,"90th_percentile":19637.35,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":14537.0,"maximum":39616.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30236.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14827.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22279.54},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32708.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":13181.78,"10th_percentile":670.12,"90th_percentile":16766.65,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":33532.36,"10th_percentile":33532.36,"90th_percentile":33532.36,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":11237.06,"10th_percentile":720.15,"90th_percentile":13392.37,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27319.17,"10th_percentile":27319.17,"90th_percentile":27319.17,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"13","median_amount":1050.0,"10th_percentile":670.12,"90th_percentile":13804.35,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32389.23,"10th_percentile":32389.23,"90th_percentile":32389.23,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":13231.26,"10th_percentile":13231.26,"90th_percentile":13231.26,"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."}]}]},{"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":11731.1,"maximum":31648.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24400.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11965.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17798.78},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26394.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":26924.88},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20336.85},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":20336.85},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":26924.88},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11731.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":23130.41},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":31648.67},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11965.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11848.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11848.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26208.81},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":11731.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":27374.1},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19717.77},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":27374.1},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11848.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12317.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12200.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11848.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14959.2,"10th_percentile":14959.2,"90th_percentile":14959.2,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":11028.62,"10th_percentile":11028.62,"90th_percentile":11028.62,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":10386.74,"10th_percentile":10386.74,"90th_percentile":10386.74,"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."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Mcc","code_information":[{"code":"064","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16552.1,"maximum":45338.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34428.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16883.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":25497.47},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37242.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":38570.98},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29133.36},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":29133.36},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":38570.98},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16552.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":33135.25},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":45338.0},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16883.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16717.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16717.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":37545.17},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":16552.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":39214.5},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28246.51},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":39214.5},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16717.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17379.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17214.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16717.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":32884.93,"10th_percentile":32884.93,"90th_percentile":32884.93,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"18","median_amount":804.39,"10th_percentile":550.0,"90th_percentile":15842.08,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":55860.78,"10th_percentile":55860.78,"90th_percentile":55860.78},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":35301.31,"10th_percentile":35301.31,"90th_percentile":129390.48,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35297.18,"10th_percentile":35297.18,"90th_percentile":35297.18,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27593.53,"10th_percentile":27593.53,"90th_percentile":27593.53,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27419.13,"10th_percentile":27419.13,"90th_percentile":27419.13,"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":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":11895.88,"10th_percentile":748.5,"90th_percentile":14447.71,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31184.69,"10th_percentile":28034.19,"90th_percentile":31184.69,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":67461.7,"10th_percentile":67461.7,"90th_percentile":67461.7},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_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":804.39,"10th_percentile":804.39,"90th_percentile":804.39,"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":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"26","median_amount":1100.0,"10th_percentile":715.02,"90th_percentile":14839.55,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":8879.55,"10th_percentile":8879.55,"90th_percentile":8879.55,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36177.58,"10th_percentile":36177.58,"90th_percentile":36177.58,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15790.67,"10th_percentile":15790.67,"90th_percentile":15790.67,"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":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"41","median_amount":748.5,"10th_percentile":499.03,"90th_percentile":15348.16,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"1 through 10","median_amount":804.39,"10th_percentile":804.39,"90th_percentile":804.39,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"17","median_amount":1170.0,"10th_percentile":718.08,"90th_percentile":14698.15,"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."}]}]},{"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":8606.81,"maximum":22777.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17902.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8778.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12809.59},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19365.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":19377.55},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14636.22},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":14636.22},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":19377.55},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8606.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":16646.71},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":22777.21},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8778.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8692.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8692.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18862.2},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":8606.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19700.85},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14190.67},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":19700.85},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8692.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9037.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8951.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8692.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":16175.06,"10th_percentile":16175.06,"90th_percentile":16175.06,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"28","median_amount":411.21,"10th_percentile":382.64,"90th_percentile":7784.96,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12893.28,"10th_percentile":12893.28,"90th_percentile":12893.28,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"11","median_amount":18710.6,"10th_percentile":18382.21,"90th_percentile":19918.55,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14941.94,"10th_percentile":14941.94,"90th_percentile":17648.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14016.95,"10th_percentile":8628.64,"90th_percentile":14016.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6532.05,"10th_percentile":6532.05,"90th_percentile":6532.05,"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":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":5126.3,"10th_percentile":382.64,"90th_percentile":7830.98,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15691.94,"10th_percentile":15691.94,"90th_percentile":15691.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_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":411.21,"10th_percentile":411.21,"90th_percentile":411.21,"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":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":7708.22,"10th_percentile":382.64,"90th_percentile":8078.32,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"37","median_amount":700.0,"10th_percentile":382.64,"90th_percentile":8718.6,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_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":3754.63,"10th_percentile":3754.63,"90th_percentile":3754.63,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":4472.85,"10th_percentile":4472.85,"90th_percentile":4472.85,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8273.15,"10th_percentile":4500.0,"90th_percentile":61526.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5190.67,"10th_percentile":5190.67,"90th_percentile":5190.67,"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":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"49","median_amount":411.21,"10th_percentile":382.64,"90th_percentile":7857.57,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"1 through 10","median_amount":6707.45,"10th_percentile":6707.45,"90th_percentile":6707.45,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"22","median_amount":7623.07,"10th_percentile":382.64,"90th_percentile":7722.08,"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."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc","code_information":[{"code":"066","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6019.25,"maximum":15429.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12520.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6139.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8677.51},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13543.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9362.96,"10th_percentile":9362.96,"90th_percentile":9362.96,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":13914.43,"10th_percentile":13914.43,"90th_percentile":13914.43,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12203.9,"10th_percentile":12203.9,"90th_percentile":12453.9,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7648.13,"10th_percentile":3487.53,"90th_percentile":9487.53,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":5091.69,"10th_percentile":5091.69,"90th_percentile":5091.69,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10190.48,"10th_percentile":10190.48,"90th_percentile":10190.48,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":2046.32,"10th_percentile":2046.32,"90th_percentile":2046.32},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"19","median_amount":358.43,"10th_percentile":258.99,"90th_percentile":5393.05,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11145.95,"10th_percentile":11145.95,"90th_percentile":11145.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":278.33,"10th_percentile":258.99,"90th_percentile":7457.78,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":5337.7,"10th_percentile":258.99,"90th_percentile":5365.97,"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."}]}]},{"description":"Precerebral Occlusion Without Infarction With Mcc","code_information":[{"code":"067","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12246.38,"maximum":33111.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25472.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12491.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18621.65},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27554.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":99.27,"10th_percentile":99.27,"90th_percentile":99.27,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":7448.4,"maximum":19487.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15492.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7597.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10959.73},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16758.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":16579.19},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12522.56},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":12522.56},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":16579.19},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7448.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":14242.72},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":19487.9},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7597.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7522.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7522.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16138.26},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":7448.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16855.8},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12141.36},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":16855.8},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7522.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7820.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7746.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7522.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":331.69,"10th_percentile":331.69,"90th_percentile":331.69,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12150.6,"10th_percentile":12150.6,"90th_percentile":12150.6,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":331.69,"10th_percentile":331.69,"90th_percentile":331.69,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":6751.12,"10th_percentile":331.69,"90th_percentile":11273.22,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":356.46,"10th_percentile":331.69,"90th_percentile":6660.85,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":331.69,"10th_percentile":331.69,"90th_percentile":331.69,"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":"Transient Ischemia Without Thrombolytic","code_information":[{"code":"069","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6927.55,"maximum":18008.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14409.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7066.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10127.99},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15586.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":15320.98},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11572.22},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":11572.22},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":15320.98},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6927.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":13161.83},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":18008.95},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7066.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6996.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6996.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14913.52},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":6927.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15576.6},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11219.94},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":15576.6},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6996.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7273.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7204.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6996.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"15","median_amount":418.35,"10th_percentile":301.07,"90th_percentile":8072.89,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10144.47,"10th_percentile":10144.47,"90th_percentile":10144.47,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":20700.72,"10th_percentile":20700.72,"90th_percentile":20700.72},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":14867.57,"10th_percentile":14867.57,"90th_percentile":14873.42,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11674.41,"10th_percentile":11674.41,"90th_percentile":11674.41,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9253.58,"10th_percentile":9253.58,"90th_percentile":9516.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":418.35,"10th_percentile":301.07,"90th_percentile":6180.31,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9543.17,"10th_percentile":8965.32,"90th_percentile":13509.64,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":6148.44,"10th_percentile":6148.44,"90th_percentile":6148.44,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"20","median_amount":1100.0,"10th_percentile":301.07,"90th_percentile":6452.61,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":31666.14,"10th_percentile":31666.14,"90th_percentile":31666.14,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"19","median_amount":418.35,"10th_percentile":301.07,"90th_percentile":6524.63,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":6140.64,"10th_percentile":301.07,"90th_percentile":60468.01,"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."}]}]},{"description":"Other Cerebrovascular Disorders With Mcc","code_information":[{"code":"070","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13803.37,"maximum":37532.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28711.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14079.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":21108.0},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31057.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":31930.86},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24117.96},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":24117.96},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":31930.86},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13803.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":27430.91},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":37532.92},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14079.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13941.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13941.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":31081.65},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":13803.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":32463.6},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23383.78},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":32463.6},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13941.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14493.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14355.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13941.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":703.13,"10th_percentile":703.13,"90th_percentile":703.13,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31713.97,"10th_percentile":31713.97,"90th_percentile":31713.97,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":8488.14,"10th_percentile":8488.14,"90th_percentile":8488.14,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27009.17,"10th_percentile":27009.17,"90th_percentile":27009.17,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":871.89,"10th_percentile":690.0,"90th_percentile":12917.82,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1019.0,"10th_percentile":654.29,"90th_percentile":11362.87,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":8731.46,"maximum":23131.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18161.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8906.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13008.65},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19645.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9511.79,"10th_percentile":9511.79,"90th_percentile":9511.79,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19222.08,"10th_percentile":19222.08,"90th_percentile":19222.08,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8526.96,"10th_percentile":8526.96,"90th_percentile":8526.96,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":396.57,"10th_percentile":396.57,"90th_percentile":7222.07,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14368.56,"10th_percentile":14368.56,"90th_percentile":14368.56,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_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":396.57,"10th_percentile":396.57,"90th_percentile":396.57,"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":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":537.33,"10th_percentile":396.57,"90th_percentile":7956.97,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":585.0,"10th_percentile":585.0,"90th_percentile":8276.81,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":7997.79,"10th_percentile":396.57,"90th_percentile":7997.79,"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."}]}]},{"description":"Other Cerebrovascular Disorders Without Cc/Mcc","code_information":[{"code":"072","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6589.32,"maximum":17048.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13705.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6721.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9587.86},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14825.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":14503.92},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10955.07},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":10955.07},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":14503.92},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6589.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":12459.91},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":17048.53},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6721.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6655.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6655.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14118.18},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":6589.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14745.9},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10621.59},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":14745.9},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6655.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6918.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6852.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6655.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":303.37,"10th_percentile":303.37,"90th_percentile":303.37,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":303.37,"10th_percentile":303.37,"90th_percentile":303.37,"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."}]}]},{"description":"Cranial And Peripheral Nerve Disorders With Mcc","code_information":[{"code":"073","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13323.01,"maximum":36168.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27711.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13589.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":20340.92},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29976.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":30770.47},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23241.49},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":23241.49},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":30770.47},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13323.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":26434.05},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":36168.94},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13589.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13456.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13456.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29952.12},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":13323.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":31283.85},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22534.0},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":31283.85},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13456.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13989.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13855.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13456.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":24162.11,"10th_percentile":24162.11,"90th_percentile":24162.11,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":11261.86,"10th_percentile":11261.86,"90th_percentile":11261.86,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20998.89,"10th_percentile":20998.89,"90th_percentile":20998.89,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30139.2,"10th_percentile":30139.2,"90th_percentile":30139.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21708.55,"10th_percentile":21708.55,"90th_percentile":21708.55,"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":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":625.0,"10th_percentile":625.0,"90th_percentile":625.0,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":8769.57,"maximum":23239.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18240.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8944.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13069.51},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19731.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":392.24,"10th_percentile":392.24,"90th_percentile":392.24,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13216.59,"10th_percentile":13216.59,"90th_percentile":13216.59,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":16904.21,"10th_percentile":16904.21,"90th_percentile":16904.21},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":19031.31,"10th_percentile":19031.31,"90th_percentile":19357.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19012.33,"10th_percentile":19012.33,"90th_percentile":19012.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14930.17,"10th_percentile":14930.17,"90th_percentile":19917.12,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"1 through 10","median_amount":3633.1,"10th_percentile":3633.1,"90th_percentile":3633.1,"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":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":539.85,"10th_percentile":392.24,"90th_percentile":7881.38,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":4596.78,"10th_percentile":4596.78,"90th_percentile":4596.78,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18958.13,"10th_percentile":18958.13,"90th_percentile":18958.13,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":539.85,"10th_percentile":421.53,"90th_percentile":8398.44,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"1 through 10","median_amount":7844.8,"10th_percentile":7844.8,"90th_percentile":7844.8,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":392.24,"10th_percentile":392.24,"90th_percentile":7929.23,"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."}]}]},{"description":"Viral Meningitis With Cc/Mcc","code_information":[{"code":"075","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15809.74,"maximum":43230.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32884.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16125.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":24311.98},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35571.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":36777.65},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27778.82},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":27778.82},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":36777.65},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15809.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":31594.65},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":43230.04},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16125.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15967.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15967.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":7137.16,"maximum":18604.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14845.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7279.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10462.71},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16058.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":15827.34},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11954.67},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":11954.67},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":15827.34},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7137.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":13596.82},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":18604.13},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7279.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7208.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7208.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15406.4},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":7137.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16091.4},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11590.76},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":16091.4},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7208.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7494.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7422.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7208.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":14956.22,"maximum":40806.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31108.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15255.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22948.99},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33651.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":34715.8},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26221.47},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":26221.47},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":34715.8},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14956.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":29823.37},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":40806.45},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15255.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15105.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15105.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":33792.52},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":14956.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":35295.0},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25423.26},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":35295.0},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15105.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15704.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15554.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15105.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":6287.32,"10th_percentile":6287.32,"90th_percentile":6287.32,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":7696.12,"maximum":20191.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16007.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7850.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11355.31},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17316.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":17177.61},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12974.56},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":12974.56},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":17177.61},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7696.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":14756.8},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":20191.3},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7850.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7773.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7773.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16720.76},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":7696.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17464.2},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12579.6},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":17464.2},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7773.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8080.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8003.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7773.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":6894.02,"10th_percentile":6894.02,"90th_percentile":6894.02,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":18732.36,"maximum":51528.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38963.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19107.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":28979.12},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42147.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":43837.81},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33111.49},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":33111.49},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":43837.81},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18732.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":37659.83},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":51528.85},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19107.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18919.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18919.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":42671.92},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":18732.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":44569.2},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32103.54},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":44569.2},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18919.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19668.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19481.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18919.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":15582.2,"10th_percentile":15582.2,"90th_percentile":15582.2,"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":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":873.05,"10th_percentile":873.05,"90th_percentile":17052.32,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":42318.13,"10th_percentile":42318.13,"90th_percentile":42318.13,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":16550.28,"10th_percentile":16550.28,"90th_percentile":16550.28,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32589.53,"10th_percentile":32589.53,"90th_percentile":32589.53,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1197.02,"10th_percentile":938.24,"90th_percentile":17061.62,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":7777.75,"10th_percentile":7777.75,"90th_percentile":17103.15,"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."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour With Cc","code_information":[{"code":"083","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11667.58,"maximum":31468.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24268.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11900.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17697.35},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26252.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":26771.44},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20220.95},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":20220.95},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":26771.44},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11667.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":22998.6},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":31468.31},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11900.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11784.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11784.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26059.45},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":11667.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":27218.1},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19605.41},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":27218.1},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11784.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12250.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12134.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11784.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":523.18,"10th_percentile":523.18,"90th_percentile":523.18,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_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":523.18,"10th_percentile":523.18,"90th_percentile":523.18,"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":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":562.25,"10th_percentile":562.25,"90th_percentile":562.25,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25287.2,"10th_percentile":25287.2,"90th_percentile":25287.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"15","median_amount":886.0,"10th_percentile":523.18,"90th_percentile":10378.69,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":10300.8,"10th_percentile":562.25,"90th_percentile":10399.69,"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":"Traumatic Stupor And Coma >1 Hour Without Cc/Mcc","code_information":[{"code":"084","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8174.09,"maximum":21548.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17002.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8337.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12118.59},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18391.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":18332.24},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13846.67},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":13846.67},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":18332.24},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8174.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":15748.72},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":21548.51},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8337.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8255.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8255.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17844.69},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":8174.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18638.1},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13425.17},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":18638.1},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8255.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8582.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8501.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8255.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":7273.18,"10th_percentile":7273.18,"90th_percentile":7273.78,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14388.78,"10th_percentile":14388.78,"90th_percentile":14388.78,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1542.83,"10th_percentile":1542.83,"90th_percentile":1542.83,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":6973.9,"10th_percentile":386.63,"90th_percentile":7678.8,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":500.57,"10th_percentile":359.77,"90th_percentile":7680.79,"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."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour With Mcc","code_information":[{"code":"085","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18623.58,"maximum":51219.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38737.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18996.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":28805.42},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41903.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":43575.04},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32913.02},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":32913.02},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":43575.04},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18623.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":37434.1},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":51219.99},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18996.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18809.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18809.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":776.01,"10th_percentile":776.01,"90th_percentile":776.01,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":9629.88,"10th_percentile":852.66,"90th_percentile":18766.37,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":41211.74,"10th_percentile":41211.74,"90th_percentile":41211.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":16499.95,"10th_percentile":852.66,"90th_percentile":16667.03,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":10928.39,"maximum":29369.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22731.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11146.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16516.93},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24588.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":24985.79},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18872.21},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":18872.21},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":24985.79},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10928.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":21464.59},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":29369.37},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11146.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11037.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11037.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":24321.28},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":10928.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25402.65},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18297.72},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":25402.65},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11037.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11474.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11365.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11037.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":20738.48,"10th_percentile":20738.48,"90th_percentile":20738.48,"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":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":493.54,"10th_percentile":493.54,"90th_percentile":4194.0,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":8180.44,"10th_percentile":493.54,"90th_percentile":10188.6,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":682.25,"10th_percentile":493.54,"90th_percentile":10789.5,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":5856.0,"10th_percentile":5856.0,"90th_percentile":5856.0,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25402.65,"10th_percentile":25402.65,"90th_percentile":25402.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23854.07,"10th_percentile":23854.07,"90th_percentile":23854.07,"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":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"13","median_amount":530.39,"10th_percentile":493.54,"90th_percentile":10130.94,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":9828.74,"10th_percentile":682.25,"90th_percentile":10262.65,"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."}]}]},{"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":7847.77,"maximum":20621.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16323.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8004.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11597.48},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17657.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":17543.95},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13251.26},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":13251.26},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":17543.95},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7847.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":15071.51},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":20621.91},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8004.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7926.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7926.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17077.36},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":7847.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17836.65},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12847.88},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":17836.65},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7926.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8240.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8161.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7926.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":357.47,"10th_percentile":332.63,"90th_percentile":7139.36,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11208.24,"10th_percentile":11208.24,"90th_percentile":11208.24,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"1 through 10","median_amount":2615.48,"10th_percentile":2615.48,"90th_percentile":2615.48,"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":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":6749.01,"10th_percentile":6749.01,"90th_percentile":6749.01,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"11","median_amount":357.47,"10th_percentile":332.63,"90th_percentile":6742.99,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":332.63,"10th_percentile":332.63,"90th_percentile":6756.99,"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."}]}]},{"description":"Concussion With Mcc","code_information":[{"code":"088","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11318.23,"maximum":30476.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23541.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11544.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17139.47},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25466.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":25927.52},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19583.53},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":19583.53},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":25927.52},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11318.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":22273.61},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":30476.33},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11544.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11431.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11431.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25237.97},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":11318.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26360.1},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18987.38},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":26360.1},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11431.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11884.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11770.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11431.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":9307.89,"maximum":24767.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19360.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9494.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13929.15},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20942.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":21071.15},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15915.42},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":15915.42},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":21071.15},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9307.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":18101.63},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":24767.94},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9494.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9400.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9400.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20510.75},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":9307.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21422.7},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15430.94},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":21422.7},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9400.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9773.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9680.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9400.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":403.42,"10th_percentile":403.42,"90th_percentile":403.42,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":8103.89,"10th_percentile":8103.89,"90th_percentile":8103.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Concussion Without Cc/Mcc","code_information":[{"code":"090","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7121.28,"maximum":18559.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14812.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7263.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10437.35},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16022.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":15788.98},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11925.7},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":11925.7},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":15788.98},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7121.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":13563.87},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":18559.04},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7263.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7192.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7192.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15369.06},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":7121.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16052.4},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11562.67},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":16052.4},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7192.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7477.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7406.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7192.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":6305.29,"10th_percentile":6305.29,"90th_percentile":6305.29},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"1 through 10","median_amount":2930.28,"10th_percentile":2930.28,"90th_percentile":2930.28,"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":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13069.89,"10th_percentile":13069.89,"90th_percentile":13069.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":14529.06,"maximum":39593.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30220.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14819.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22266.86},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32690.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":34648.56,"10th_percentile":34648.56,"90th_percentile":34648.56,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":39081.15,"10th_percentile":39081.15,"90th_percentile":39081.15,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":12896.93,"10th_percentile":919.76,"90th_percentile":12958.6,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"1 through 10","median_amount":52181.11,"10th_percentile":52181.11,"90th_percentile":52181.11},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8385.93,"10th_percentile":8385.93,"90th_percentile":8385.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19136.06,"10th_percentile":19136.06,"90th_percentile":19136.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":840.0,"10th_percentile":840.0,"90th_percentile":13483.81,"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":"Other Disorders Of Nervous System With Cc","code_information":[{"code":"092","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8707.64,"maximum":23063.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18111.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8881.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12970.62},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19592.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":19621.14},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14820.2},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":14820.2},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":19621.14},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8707.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":16855.97},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":23063.54},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8881.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8794.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8794.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19099.31},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":8707.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19948.5},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14369.06},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":19948.5},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8794.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9143.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9055.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8794.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":1833.84,"10th_percentile":1833.84,"90th_percentile":1833.84,"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":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":9351.87,"10th_percentile":398.37,"90th_percentile":10267.87,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4821.6,"10th_percentile":4821.6,"90th_percentile":4821.6,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"1 through 10","median_amount":48595.26,"10th_percentile":48595.26,"90th_percentile":48595.26},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":20375.01,"10th_percentile":20375.01,"90th_percentile":20375.01,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14593.12,"10th_percentile":13858.52,"90th_percentile":61465.45,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12083.0,"10th_percentile":12083.0,"90th_percentile":12083.0,"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":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":6112.01,"10th_percentile":398.37,"90th_percentile":7916.17,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16380.78,"10th_percentile":16380.78,"90th_percentile":16380.78,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":398.37,"10th_percentile":265.6,"90th_percentile":6348.47,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":428.11,"10th_percentile":428.11,"90th_percentile":428.11,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":428.11,"10th_percentile":398.37,"90th_percentile":8021.66,"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":"Other Disorders Of Nervous System Without Cc/Mcc","code_information":[{"code":"093","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6907.7,"maximum":17952.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14368.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7045.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10096.29},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15542.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12304.89,"10th_percentile":12304.89,"90th_percentile":12304.89,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10879.71,"10th_percentile":10879.71,"90th_percentile":10879.71,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":297.0,"10th_percentile":297.0,"90th_percentile":6027.57,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9948.92,"10th_percentile":9948.92,"90th_percentile":9948.92,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":6025.12,"10th_percentile":6025.12,"90th_percentile":6025.12,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1776.35,"10th_percentile":1776.35,"90th_percentile":1776.35,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":3077.51,"10th_percentile":3077.51,"90th_percentile":3077.51,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":297.0,"10th_percentile":270.0,"90th_percentile":9306.79,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":28528.41,"maximum":79344.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":59339.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29098.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":44622.47},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":64188.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":174497.34,"10th_percentile":174497.34,"90th_percentile":174497.34,"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":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":41963.74,"10th_percentile":41963.74,"90th_percentile":41963.74,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":17503.81,"10th_percentile":1350.78,"90th_percentile":19357.72,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34950.06,"10th_percentile":34950.06,"90th_percentile":34950.06,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":46745.4,"10th_percentile":46745.4,"90th_percentile":46745.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":19723.53,"10th_percentile":19723.53,"90th_percentile":19723.53,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":21063.46,"maximum":58148.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43812.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21484.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":32701.68},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":47392.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":49469.06},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37364.87},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":37364.87},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":49469.06},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21063.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":42497.48},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":58148.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21484.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21274.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21274.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":48153.41},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":21063.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":50294.4},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36227.44},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":50294.4},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21274.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22116.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21906.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21274.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":15918.13,"10th_percentile":15918.13,"90th_percentile":15918.13,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":29262.04,"maximum":81428.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":60865.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29847.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":45794.01},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":65839.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":69274.32},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52324.15},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":52324.15},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":69274.32},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29262.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":59511.63},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":81428.03},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29847.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29554.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29554.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":67431.94},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":29262.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":70430.1},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":50731.34},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":70430.1},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29554.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30725.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30432.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29554.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":56878.5,"10th_percentile":56878.5,"90th_percentile":56878.5,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":25502.58,"10th_percentile":25502.58,"90th_percentile":25502.58,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":18806.2,"maximum":51738.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39116.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19182.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":29097.04},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42313.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":44016.18},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33246.22},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":33246.22},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":44016.18},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18806.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":37813.07},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":51738.52},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19182.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18994.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18994.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":42845.55},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":18806.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":44750.55},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32234.17},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":44750.55},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18994.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19746.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19558.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18994.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"1 through 10","median_amount":17252.75,"10th_percentile":17252.75,"90th_percentile":17252.75},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":7986.58,"10th_percentile":7986.58,"90th_percentile":7986.58,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":11402.39,"maximum":30715.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23716.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11630.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17273.87},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25655.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":26130.83},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19737.09},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":19737.09},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":26130.83},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11402.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":22448.26},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":30715.31},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11630.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11516.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11516.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25435.87},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":11402.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26566.8},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19136.27},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":26566.8},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11516.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11972.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11858.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11516.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":25278.75,"10th_percentile":25278.75,"90th_percentile":25278.75,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14024.86,"10th_percentile":14024.86,"90th_percentile":14024.86,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":15962.98,"maximum":43665.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33203.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16282.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":24556.69},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35916.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":37147.82},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28058.42},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":28058.42},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":37147.82},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15962.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":31912.65},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":43665.16},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16282.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16122.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16122.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":36159.86},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":15962.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":37767.6},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27204.29},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":37767.6},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16122.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16761.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16601.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16122.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":636.0,"10th_percentile":636.0,"90th_percentile":636.0,"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":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":747.03,"10th_percentile":747.03,"90th_percentile":28501.3,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":23077.38,"10th_percentile":23077.38,"90th_percentile":23077.38},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":25639.13,"10th_percentile":25639.13,"90th_percentile":35125.49,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29541.58,"10th_percentile":29541.58,"90th_percentile":29541.58,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20970.86,"10th_percentile":20970.86,"90th_percentile":20970.86,"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":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":12347.65,"10th_percentile":802.82,"90th_percentile":14420.14,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29394.07,"10th_percentile":29394.07,"90th_percentile":29394.07,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":33233.76,"10th_percentile":33233.76,"90th_percentile":33233.76},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"1 through 10","median_amount":46362.95,"10th_percentile":46362.95,"90th_percentile":46362.95},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":802.82,"10th_percentile":168.27,"90th_percentile":13203.73,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":3870.74,"10th_percentile":3870.74,"90th_percentile":3870.74,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":8941.41,"10th_percentile":8941.41,"90th_percentile":20365.03,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":7791.92,"10th_percentile":802.82,"90th_percentile":13221.16,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1627.03,"10th_percentile":747.03,"90th_percentile":14656.75,"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."}]}]},{"description":"Seizures Without Mcc","code_information":[{"code":"101","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7751.7,"maximum":20349.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16123.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7906.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11444.07},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17441.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":17311.87},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13075.97},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":13075.97},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":17311.87},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7751.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":14872.14},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":20349.12},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7906.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7829.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7829.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16851.45},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":7751.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17600.7},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12677.92},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":17600.7},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7829.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8139.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8061.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7829.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":15380.97,"10th_percentile":15380.97,"90th_percentile":15380.97,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"12","median_amount":1100.0,"10th_percentile":372.71,"90th_percentile":8001.77,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13088.23,"10th_percentile":13088.23,"90th_percentile":13088.23,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":16865.37,"10th_percentile":16848.41,"90th_percentile":17412.68,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15726.75,"10th_percentile":15726.75,"90th_percentile":15726.75,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11669.33,"10th_percentile":10163.77,"90th_percentile":12790.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":346.82,"10th_percentile":346.82,"90th_percentile":346.82,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14449.49,"10th_percentile":14449.49,"90th_percentile":14449.49,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":372.71,"10th_percentile":372.71,"90th_percentile":7015.03,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":2168.66,"10th_percentile":2168.66,"90th_percentile":2168.66,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":2703.55,"10th_percentile":2703.55,"90th_percentile":3870.74,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16762.96,"10th_percentile":16762.96,"90th_percentile":16762.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"14","median_amount":5453.78,"10th_percentile":346.82,"90th_percentile":5827.44,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"1 through 10","median_amount":346.82,"10th_percentile":346.82,"90th_percentile":346.82,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":7029.26,"10th_percentile":346.82,"90th_percentile":7047.26,"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."}]}]},{"description":"Headaches With Mcc","code_information":[{"code":"102","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9484.94,"maximum":25270.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19728.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9674.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14211.89},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21341.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":21498.86},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16238.48},{"payer_name":"Blue Cross","plan_name":"Health Options - 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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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15517.48,"10th_percentile":15517.48,"90th_percentile":15517.48,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":6419.6,"10th_percentile":468.88,"90th_percentile":8616.34,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":7225.29,"maximum":18854.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15028.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7369.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10603.45},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16256.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":8686.98,"10th_percentile":8686.98,"90th_percentile":8686.98,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3056.4,"10th_percentile":3056.4,"90th_percentile":3056.4,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"1 through 10","median_amount":38824.73,"10th_percentile":38824.73,"90th_percentile":38824.73},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":21473.78,"10th_percentile":19150.95,"90th_percentile":22344.53},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":15837.28,"10th_percentile":15728.51,"90th_percentile":16272.34,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12851.9,"10th_percentile":12851.9,"90th_percentile":13486.12,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4840.22,"10th_percentile":4840.22,"90th_percentile":4840.22,"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":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":437.99,"10th_percentile":343.8,"90th_percentile":6080.67,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13328.59,"10th_percentile":12728.59,"90th_percentile":13328.59,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":54756.81,"10th_percentile":54756.81,"90th_percentile":54756.81},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"1 through 10","median_amount":47673.25,"10th_percentile":47673.25,"90th_percentile":47673.25},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1424.88,"10th_percentile":1424.88,"90th_percentile":2317.32,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_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":2916.36,"10th_percentile":2916.36,"90th_percentile":2916.36,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":2916.36,"10th_percentile":2916.36,"90th_percentile":2916.36,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":6898.72,"10th_percentile":6898.72,"90th_percentile":6898.72,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15462.59,"10th_percentile":15462.59,"90th_percentile":16098.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10746.35,"10th_percentile":10746.35,"90th_percentile":10746.35,"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":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":319.92,"10th_percentile":319.92,"90th_percentile":6625.59,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":19252.41,"maximum":53005.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40045.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19637.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":29809.6},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43317.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":12772.0,"maximum":34604.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26565.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13027.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19461.0},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28737.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":29439.38},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22236.1},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":22236.1},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":29439.38},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12772.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":25290.55},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":34604.32},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13027.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12899.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12899.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":28656.43},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":12772.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29930.55},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21559.21},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":29930.55},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12899.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13410.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13282.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12899.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":37943.47,"10th_percentile":37943.47,"90th_percentile":37943.47},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27828.7,"10th_percentile":27828.7,"90th_percentile":27828.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":14941.13,"maximum":40763.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31077.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15239.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22924.9},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33617.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":34679.36},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26193.94},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":26193.94},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":34679.36},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14941.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":29792.06},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":40763.61},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15239.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15090.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15090.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":33757.05},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":14941.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":35257.95},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25396.57},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":35257.95},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15090.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15688.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15538.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15090.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":9199.11,"maximum":24459.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19134.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9383.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13755.45},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20698.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":20808.38},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15716.95},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":15716.95},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":20808.38},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9199.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":17875.9},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":24459.07},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9383.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9291.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9291.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21155.12,"10th_percentile":21155.12,"90th_percentile":21155.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":6824.34,"maximum":17715.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14194.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6960.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9963.16},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15354.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":15071.64},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11383.88},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":11383.88},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":15071.64},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6824.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":12947.63},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":17715.86},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6960.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6892.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6892.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14670.81},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":6824.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15323.1},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11037.35},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":15323.1},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6892.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7165.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7097.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6892.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":6925.97,"maximum":18004.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14406.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7064.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10125.45},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15583.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14909.78},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":6925.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15572.7},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11217.14},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":15572.7},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6995.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7272.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7203.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6995.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":6235.51,"10th_percentile":6235.51,"90th_percentile":6235.51,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":22711.23,"10th_percentile":22711.23,"90th_percentile":23628.64},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":15059.99,"10th_percentile":15059.99,"90th_percentile":15059.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":25437.43,"10th_percentile":25437.43,"90th_percentile":25437.43},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":6477.79,"10th_percentile":6477.79,"90th_percentile":6477.79,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14607.8,"10th_percentile":13362.4,"90th_percentile":14607.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"1 through 10","median_amount":9533.0,"10th_percentile":9533.0,"90th_percentile":9533.0,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":490.64,"10th_percentile":490.64,"90th_percentile":490.64,"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."}]}]},{"description":"Other Disorders Of The Eye Without Mcc","code_information":[{"code":"125","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6681.42,"maximum":17310.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13897.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6815.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9734.94},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15033.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":14726.4},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11123.12},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":11123.12},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":14726.4},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6681.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":12651.04},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":17310.05},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6815.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6748.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6748.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14334.75},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":6681.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14972.1},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10784.52},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":14972.1},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6748.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7015.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6948.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6748.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":1446.48,"10th_percentile":1446.48,"90th_percentile":1446.48,"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":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":6387.04,"10th_percentile":6387.04,"90th_percentile":6387.04,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"1 through 10","median_amount":12016.58,"10th_percentile":12016.58,"90th_percentile":12016.58},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":15115.93,"10th_percentile":15115.93,"90th_percentile":15115.93,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12344.5,"10th_percentile":12344.5,"90th_percentile":12344.5,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9581.45,"10th_percentile":9581.45,"90th_percentile":9581.45,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":333.9,"10th_percentile":310.7,"90th_percentile":6127.37,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14698.38,"10th_percentile":14698.38,"90th_percentile":14698.38,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":439.45,"10th_percentile":412.68,"90th_percentile":1467.45,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":402.11,"10th_percentile":402.11,"90th_percentile":6286.25,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":333.9,"10th_percentile":333.9,"90th_percentile":333.9,"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":"Sinus And Mastoid Procedures With Cc/Mcc","code_information":[{"code":"135","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17814.52,"maximum":48922.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37054.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18170.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":27513.43},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40082.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":41620.6},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31436.79},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":31436.79},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":41620.6},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17814.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":35755.09},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":48922.65},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18170.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17992.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17992.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":40513.68},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":17814.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":42315.0},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30479.82},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":42315.0},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17992.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18705.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18527.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17992.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":8646.51,"maximum":22889.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17984.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8819.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12872.99},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19454.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":19473.45},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14708.65},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":14708.65},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":19473.45},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8646.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":16729.1},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":22889.94},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8819.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8732.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8732.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18955.55},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":8646.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19798.35},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14260.9},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":19798.35},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8732.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9078.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8992.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8732.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":12440.91,"maximum":33664.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25877.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12689.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18932.28},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27992.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":28639.58},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21631.99},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":21631.99},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":28639.58},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12440.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":24603.46},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":33664.19},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12689.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12565.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12565.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":27877.89},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":12440.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29117.4},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20973.49},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":29117.4},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12565.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13062.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12938.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12565.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":7621.49,"maximum":19979.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15852.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7773.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11236.13},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17148.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":16997.32},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12838.38},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":12838.38},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":16997.32},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7621.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":14601.92},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":19979.38},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7773.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7697.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7697.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16545.27},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":7621.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17280.9},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12447.57},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":17280.9},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7697.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8002.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7926.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7697.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":10396.43,"maximum":27858.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21624.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10604.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15667.44},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23391.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":34450.66,"maximum":96161.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":71657.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35139.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":54079.74},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":77513.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":81808.45},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":61791.4},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":61791.4},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":81808.45},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34450.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":70279.35},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":96161.19},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35139.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34795.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34795.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":79632.72},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":34450.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":83173.35},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":59910.4},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":83173.35},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34795.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36173.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35828.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34795.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":17902.65,"maximum":49172.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37237.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18260.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":27654.17},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40280.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":41833.5},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31597.6},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":31597.6},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":41833.5},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17902.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":35937.98},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":49172.9},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18260.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18081.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18081.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":40720.92},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":17902.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":42531.45},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30635.73},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":42531.45},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18081.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18797.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18618.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18081.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":13260.29,"maximum":35990.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27581.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13525.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":20240.76},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29835.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":30618.95},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23127.05},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":23127.05},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":30618.95},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13260.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":26303.88},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":35990.84},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13525.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13392.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13392.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"1 through 10","median_amount":25836.81,"10th_percentile":25836.81,"90th_percentile":25836.81},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":10131.24,"maximum":27105.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21072.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10333.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15243.96},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22795.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":23060.11},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17417.72},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":17417.72},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":23060.11},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10131.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":19810.3},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":27105.85},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10333.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10232.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10232.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22446.82},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":10131.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23444.85},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16887.51},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":23444.85},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10232.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10637.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10536.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10232.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":9234.39,"10th_percentile":9234.39,"90th_percentile":9234.39,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":17396.89,"maximum":47736.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36185.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17744.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":26846.51},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39143.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":40611.73},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30674.77},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":30674.77},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":40611.73},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17396.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":34888.4},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":47736.78},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17744.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17570.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17570.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":39531.65},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":17396.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":41289.3},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29741.0},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":41289.3},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17570.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18266.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18092.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17570.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":10680.67,"maximum":28665.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22215.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10894.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16121.35},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24031.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":24387.37},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18420.22},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":18420.22},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":24387.37},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10680.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":20950.51},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":28665.97},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10894.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10787.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10787.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23738.78},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":10680.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":24794.25},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17859.49},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":24794.25},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10787.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11214.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11107.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10787.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":9282.64,"10th_percentile":9282.64,"90th_percentile":9282.64,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":11900.34,"10th_percentile":11900.34,"90th_percentile":11900.34,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":6914.06,"maximum":17970.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14381.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7052.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10106.43},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15556.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":15288.38},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11547.59},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":11547.59},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":15288.38},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6914.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":13133.82},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":17970.62},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7052.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6983.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6983.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14881.78},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":6914.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15543.45},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11196.07},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":15543.45},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6983.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7259.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7190.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6983.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":6552.8,"maximum":16944.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13629.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6683.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9529.54},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14743.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":14415.69},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10888.43},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":10888.43},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":14415.69},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6552.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":12384.11},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":16944.82},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6683.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6618.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6618.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":281.27,"10th_percentile":281.27,"90th_percentile":5820.06,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"1 through 10","median_amount":21702.78,"10th_percentile":21702.78,"90th_percentile":21702.78},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":13889.5,"10th_percentile":13889.5,"90th_percentile":13969.13,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12759.19,"10th_percentile":11118.56,"90th_percentile":13722.42,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9956.08,"10th_percentile":8503.54,"90th_percentile":46812.18,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":302.27,"10th_percentile":281.27,"90th_percentile":5256.57,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11055.52,"10th_percentile":11055.52,"90th_percentile":11875.81,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"11","median_amount":393.63,"10th_percentile":281.27,"90th_percentile":5736.9,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":2649.99,"10th_percentile":2649.99,"90th_percentile":2649.99,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13594.78,"10th_percentile":13594.78,"90th_percentile":13594.78,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13594.78,"10th_percentile":13594.78,"90th_percentile":13594.78,"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":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"25","median_amount":302.27,"10th_percentile":281.27,"90th_percentile":6092.64,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":5770.8,"10th_percentile":393.63,"90th_percentile":5782.5,"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":"Epistaxis With Mcc","code_information":[{"code":"150","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11157.05,"maximum":30018.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23206.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11380.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16882.09},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25103.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":25538.17},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19289.44},{"payer_name":"Blue Cross","plan_name":"Health Options - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":6413.06,"maximum":16548.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13339.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6541.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9306.39},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14429.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":14078.12},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10633.46},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":10633.46},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":14078.12},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6413.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":12094.12},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":16548.03},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6541.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6477.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6477.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13703.71},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":6413.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14313.0},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10309.76},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":14313.0},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6477.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6669.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6477.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":12666.33,"10th_percentile":12666.33,"90th_percentile":12666.33,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":580.0,"10th_percentile":580.0,"90th_percentile":580.0,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":306.51,"10th_percentile":306.51,"90th_percentile":306.51,"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."}]}]},{"description":"Otitis Media And Uri With Mcc","code_information":[{"code":"152","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9971.65,"maximum":26652.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20741.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10171.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14989.11},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22436.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":22674.6},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17126.53},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":17126.53},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":22674.6},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9971.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":19479.11},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":26652.7},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10171.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10071.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10071.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":6881.64,"10th_percentile":6881.64,"90th_percentile":6881.64,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"1 through 10","median_amount":3509.51,"10th_percentile":3509.51,"90th_percentile":3509.51,"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":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1826.69,"10th_percentile":427.01,"90th_percentile":8632.18,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":7332.07,"10th_percentile":7332.07,"90th_percentile":7332.07,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":6713.53,"10th_percentile":6713.53,"90th_percentile":6713.53,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":427.01,"10th_percentile":427.01,"90th_percentile":427.01,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":6446.41,"maximum":16642.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13408.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6575.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9359.64},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14504.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":8388.19,"10th_percentile":8388.19,"90th_percentile":8388.19},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":13277.95,"10th_percentile":13277.95,"90th_percentile":13277.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12980.7,"10th_percentile":12980.7,"90th_percentile":12980.7,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9144.6,"10th_percentile":8110.66,"90th_percentile":9963.37,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10857.32,"10th_percentile":10857.32,"90th_percentile":11157.32,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":15517.18,"10th_percentile":15517.18,"90th_percentile":15517.18},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"1 through 10","median_amount":1561.49,"10th_percentile":1561.49,"90th_percentile":1561.49,"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":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":5508.28,"10th_percentile":5508.28,"90th_percentile":5508.28,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":386.61,"10th_percentile":287.8,"90th_percentile":6058.11,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_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":3001.87,"10th_percentile":3001.87,"90th_percentile":3001.87,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":1452.51,"10th_percentile":1419.54,"90th_percentile":3190.46,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1371.43,"10th_percentile":1371.43,"90th_percentile":1371.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":4038.35,"10th_percentile":4038.35,"90th_percentile":4038.35,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":5522.78,"10th_percentile":5522.78,"90th_percentile":5522.78,"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."}]}]},{"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":12999.07,"maximum":35249.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27038.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13259.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19823.62},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29247.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19395.5,"10th_percentile":19395.5,"90th_percentile":19395.5,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":12207.85,"10th_percentile":12207.85,"90th_percentile":12207.85,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":7862.06,"maximum":20662.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16353.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8019.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11620.3},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17689.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":7192.14,"10th_percentile":7192.14,"90th_percentile":7192.14,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":7377.46,"10th_percentile":7377.46,"90th_percentile":7377.46,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":377.53,"10th_percentile":377.53,"90th_percentile":377.53,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":6072.44,"maximum":15580.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12630.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6193.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8762.46},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13662.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":13255.3},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10011.97},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":10011.97},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":13255.3},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6072.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":11387.25},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":15580.85},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6193.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6133.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6133.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9941.21,"10th_percentile":9941.21,"90th_percentile":9941.21,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7488.36,"10th_percentile":7488.36,"90th_percentile":7488.36,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":4286.97,"10th_percentile":4286.97,"90th_percentile":4286.97,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":2820.38,"10th_percentile":2820.38,"90th_percentile":2820.38,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":361.94,"10th_percentile":361.94,"90th_percentile":5535.43,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":14216.23,"maximum":38705.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29569.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14500.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":21767.31},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31986.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":32928.22},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24871.28},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":24871.28},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":32928.22},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14216.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":28287.71},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":38705.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14500.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14358.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14358.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":32052.48},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":14216.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":33477.6},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24114.17},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":33477.6},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14358.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14927.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14784.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14358.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":12184.33,"10th_percentile":12184.33,"90th_percentile":12184.33,"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."}]}]},{"description":"Dental And Oral Diseases With Cc","code_information":[{"code":"158","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7808.86,"maximum":20511.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16242.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7965.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11535.35},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17569.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":17449.96},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13180.27},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":13180.27},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":17449.96},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7808.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":14990.77},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":20511.44},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7965.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7886.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7886.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16985.88},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":7808.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17741.1},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12779.05},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":17741.1},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7886.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8199.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8121.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7886.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":7258.01,"10th_percentile":7258.01,"90th_percentile":7258.01,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12381.65,"10th_percentile":12381.65,"90th_percentile":12381.65,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"1 through 10","median_amount":3575.03,"10th_percentile":3575.03,"90th_percentile":3575.03,"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":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":353.94,"10th_percentile":353.94,"90th_percentile":7789.36,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":2436.42,"10th_percentile":2063.34,"90th_percentile":2820.38,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4143.36,"10th_percentile":4143.36,"90th_percentile":12046.45,"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":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":5698.36,"10th_percentile":5698.36,"90th_percentile":5698.36,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":476.49,"10th_percentile":476.49,"90th_percentile":7346.34,"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."}]}]},{"description":"Dental And Oral Diseases Without Cc/Mcc","code_information":[{"code":"159","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6210.6,"maximum":15973.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12918.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6334.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8983.07},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13973.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":1764.07,"10th_percentile":1764.07,"90th_percentile":1764.07,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":36169.61,"maximum":101042.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":75232.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36893.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":56824.74},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":81381.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15956.52,"10th_percentile":15956.52,"90th_percentile":15956.52,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"1 through 10","median_amount":47011.68,"10th_percentile":47011.68,"90th_percentile":47011.68},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":66355.85,"10th_percentile":66355.85,"90th_percentile":66355.85},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":81194.04,"10th_percentile":81194.04,"90th_percentile":81194.04,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":71265.35,"10th_percentile":71265.35,"90th_percentile":71265.35,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":63533.21,"10th_percentile":63533.21,"90th_percentile":63533.21,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":1734.37,"10th_percentile":1734.37,"90th_percentile":32317.73,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":72258.43,"10th_percentile":72258.43,"90th_percentile":72258.43,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":33865.15,"10th_percentile":33865.15,"90th_percentile":33865.15,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":33070.27,"10th_percentile":1734.37,"90th_percentile":33823.04,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":33502.8,"10th_percentile":33502.8,"90th_percentile":33502.8,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1863.86,"10th_percentile":1863.86,"90th_percentile":54132.55,"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."}]}]},{"description":"Major Chest Procedures With Cc","code_information":[{"code":"164","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20625.19,"maximum":56903.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42900.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21037.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":32001.8},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":46406.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":48410.32},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36565.19},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":36565.19},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":48410.32},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20625.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":41587.95},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":56903.58},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21037.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20831.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20831.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":47122.83},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":20625.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":49218.0},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35452.1},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":49218.0},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20831.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21656.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21450.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20831.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":22531.48,"10th_percentile":22531.48,"90th_percentile":38807.33,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":18661.31,"10th_percentile":18661.31,"90th_percentile":19522.45,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":55827.19,"10th_percentile":55827.19,"90th_percentile":55827.19},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38047.81,"10th_percentile":38047.81,"90th_percentile":38047.81,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34694.33,"10th_percentile":34694.33,"90th_percentile":34694.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":17323.85,"10th_percentile":17323.85,"90th_percentile":17323.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":63466.99,"10th_percentile":63466.99,"90th_percentile":63466.99,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":18433.46,"10th_percentile":947.11,"90th_percentile":18441.56,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34158.21,"10th_percentile":34158.21,"90th_percentile":34158.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":17152.21,"10th_percentile":947.11,"90th_percentile":20596.06,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":19334.82,"10th_percentile":19334.82,"90th_percentile":19334.82,"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."}]}]},{"description":"Major Chest Procedures Without Cc/Mcc","code_information":[{"code":"165","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15783.54,"maximum":43155.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32829.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16099.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":24270.14},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35512.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":8161.91,"10th_percentile":8161.91,"90th_percentile":8161.91},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":840.9,"10th_percentile":840.9,"90th_percentile":13629.87,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":13778.89,"10th_percentile":13778.89,"90th_percentile":13778.89,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":27044.51,"10th_percentile":27044.51,"90th_percentile":27044.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"1 through 10","median_amount":22734.32,"10th_percentile":22734.32,"90th_percentile":22734.32},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_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":1957.51,"10th_percentile":1957.51,"90th_percentile":1957.51,"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":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1957.51,"10th_percentile":1448.81,"90th_percentile":28534.85,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1957.51,"10th_percentile":1448.81,"90th_percentile":28062.86,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1448.81,"10th_percentile":1448.81,"90th_percentile":28058.96,"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."}]}]},{"description":"Other Respiratory System O.R. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":32748.32,"10th_percentile":32748.32,"90th_percentile":32748.32,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3682.44,"10th_percentile":3682.44,"90th_percentile":3682.44,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25925.56,"10th_percentile":25925.56,"90th_percentile":25925.56,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":880.94,"10th_percentile":880.94,"90th_percentile":15891.97,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":12190.47,"10th_percentile":687.55,"90th_percentile":13514.67,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":13525.86,"10th_percentile":13525.86,"90th_percentile":13525.86,"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."}]}]},{"description":"Other Respiratory System O.R. 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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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":24217.13,"maximum":67102.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":50371.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24701.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":37737.78},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":54488.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":57087.35},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43119.11},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":43119.11},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":57087.35},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24217.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":49042.14},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":67102.94},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24701.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24459.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24459.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":55569.09},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":24217.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":58039.8},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41806.51},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":58039.8},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24459.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25427.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25185.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24459.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":11491.32,"maximum":30967.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23901.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11721.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17415.87},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25855.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":26345.65},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19899.34},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":19899.34},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":26345.65},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11491.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":22632.81},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":30967.81},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11721.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11606.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11606.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":25560.56,"10th_percentile":25343.03,"90th_percentile":26255.75,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":9351.33,"10th_percentile":530.22,"90th_percentile":10408.84,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20193.7,"10th_percentile":20193.7,"90th_percentile":22800.39,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"22","median_amount":6234.29,"10th_percentile":530.22,"90th_percentile":10494.93,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_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":4312.53,"10th_percentile":4312.53,"90th_percentile":4312.53,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25627.3,"10th_percentile":25627.3,"90th_percentile":27477.45,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"18","median_amount":719.38,"10th_percentile":530.22,"90th_percentile":10774.93,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"1 through 10","median_amount":11152.33,"10th_percentile":11152.33,"90th_percentile":11152.33,"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] [MSDRG Base Rate: 104% of Medicare]","count":"1 through 10","median_amount":10486.86,"10th_percentile":10486.86,"90th_percentile":10486.86,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":719.38,"10th_percentile":530.22,"90th_percentile":10527.97,"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."}]}]},{"description":"Pulmonary Embolism Without Mcc","code_information":[{"code":"176","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6976.78,"maximum":18148.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14511.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7116.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10206.6},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15697.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":15439.9},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11662.04},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":11662.04},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":15439.9},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6976.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":13263.99},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":18148.73},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7116.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7046.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7046.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15029.27},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":6976.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15697.5},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11307.03},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":15697.5},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7046.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7325.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7255.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7046.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":12900.51,"10th_percentile":12900.51,"90th_percentile":12900.51,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"20","median_amount":550.0,"10th_percentile":306.49,"90th_percentile":6327.84,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10327.05,"10th_percentile":10327.05,"90th_percentile":10327.05,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"1 through 10","median_amount":28186.11,"10th_percentile":28186.11,"90th_percentile":28186.11},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":15115.01,"10th_percentile":15115.01,"90th_percentile":16094.3,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12627.31,"10th_percentile":12627.31,"90th_percentile":12768.92,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11227.07,"10th_percentile":11227.07,"90th_percentile":11227.07,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":306.49,"10th_percentile":306.49,"90th_percentile":6083.35,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12468.92,"10th_percentile":12168.92,"90th_percentile":12768.92,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_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":306.49,"10th_percentile":306.49,"90th_percentile":306.49,"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":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"15","median_amount":421.6,"10th_percentile":306.49,"90th_percentile":6243.29,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":2129.48,"10th_percentile":2129.48,"90th_percentile":2129.48,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14813.31,"10th_percentile":14813.31,"90th_percentile":15131.31,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11053.58,"10th_percentile":11053.58,"90th_percentile":11053.58,"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":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14813.31,"10th_percentile":14813.31,"90th_percentile":14813.31,"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":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"15","median_amount":421.6,"10th_percentile":306.49,"90th_percentile":6267.64,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"1 through 10","median_amount":6063.14,"10th_percentile":6063.14,"90th_percentile":6063.14,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":6212.68,"10th_percentile":306.49,"90th_percentile":6582.08,"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."}]}]},{"description":"Respiratory Infections And Inflammations With Mcc","code_information":[{"code":"177","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12992.72,"maximum":35231.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27024.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13252.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19813.47},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29233.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":20569.21,"10th_percentile":20569.21,"90th_percentile":20569.21},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":30357.0,"10th_percentile":30357.0,"90th_percentile":30357.0,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21584.37,"10th_percentile":21584.37,"90th_percentile":21584.37,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34656.14,"10th_percentile":34656.14,"90th_percentile":34656.14,"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":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"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":7392.49,"10th_percentile":608.27,"90th_percentile":11931.64,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23788.16,"10th_percentile":23788.16,"90th_percentile":24741.87,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"1 through 10","median_amount":15567.09,"10th_percentile":15567.09,"90th_percentile":15567.09},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_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":653.68,"10th_percentile":653.68,"90th_percentile":653.68,"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":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"28","median_amount":653.68,"10th_percentile":608.27,"90th_percentile":11989.54,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":16936.2,"10th_percentile":16936.2,"90th_percentile":16936.2,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":8985.42,"10th_percentile":8985.42,"90th_percentile":9151.11,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29399.29,"10th_percentile":29399.29,"90th_percentile":29399.29,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"48","median_amount":818.42,"10th_percentile":608.27,"90th_percentile":12194.31,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"1 through 10","median_amount":10208.61,"10th_percentile":10208.61,"90th_percentile":10208.61,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"18","median_amount":834.31,"10th_percentile":608.27,"90th_percentile":12056.17,"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."}]}]},{"description":"Respiratory Infections And Inflammations With Cc","code_information":[{"code":"178","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8334.48,"maximum":22003.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17335.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8501.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12374.7},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18752.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":18719.68},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14139.31},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":14139.31},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":18719.68},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8334.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":16081.55},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":22003.92},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8501.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8417.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8417.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18221.82},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":8334.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19032.0},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13708.9},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":19032.0},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8417.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8751.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8667.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8417.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"12","median_amount":511.15,"10th_percentile":401.18,"90th_percentile":7786.16,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"1 through 10","median_amount":24535.62,"10th_percentile":24535.62,"90th_percentile":24535.62},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":18384.48,"10th_percentile":18384.48,"90th_percentile":18384.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":401.18,"10th_percentile":373.31,"90th_percentile":7478.21,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12322.63,"10th_percentile":12322.63,"90th_percentile":12322.63,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":7839.29,"10th_percentile":7839.29,"90th_percentile":7839.29,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"12","median_amount":756.2,"10th_percentile":373.31,"90th_percentile":7438.9,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":2912.04,"10th_percentile":2912.04,"90th_percentile":2912.04,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":8985.42,"10th_percentile":8985.42,"90th_percentile":8985.42,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17760.4,"10th_percentile":17760.4,"90th_percentile":17760.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"13","median_amount":401.18,"10th_percentile":373.31,"90th_percentile":7536.3,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"1 through 10","median_amount":5708.52,"10th_percentile":5708.52,"90th_percentile":5708.52,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":7521.94,"10th_percentile":7521.94,"90th_percentile":7521.94,"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."}]}]},{"description":"Respiratory Infections And Inflammations Without Cc/Mcc","code_information":[{"code":"179","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6579.79,"maximum":17021.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13685.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6711.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9572.65},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14804.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":5265.7,"10th_percentile":395.41,"90th_percentile":5377.82,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12205.5,"10th_percentile":12205.5,"90th_percentile":12205.5,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":5869.31,"10th_percentile":311.25,"90th_percentile":5924.41,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":8985.42,"10th_percentile":8985.42,"90th_percentile":8985.42,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":395.41,"10th_percentile":311.25,"90th_percentile":5873.33,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":14606.87,"maximum":39814.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30382.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14899.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22391.11},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32865.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":33871.88},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25584.04},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":25584.04},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":33871.88},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14606.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":29098.38},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":39814.47},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14899.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14752.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14752.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"11","median_amount":12948.22,"10th_percentile":657.67,"90th_percentile":14662.79,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24091.68,"10th_percentile":24091.68,"90th_percentile":24091.68,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":11747.14,"10th_percentile":11747.14,"90th_percentile":11747.14,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":63728.7,"10th_percentile":63728.7,"90th_percentile":63728.7},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":12795.65,"10th_percentile":924.89,"90th_percentile":35521.93,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":7806.25,"10th_percentile":7806.25,"90th_percentile":7806.25,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"15","median_amount":657.67,"10th_percentile":657.67,"90th_percentile":12929.72,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":924.89,"10th_percentile":706.78,"90th_percentile":13689.14,"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":"Respiratory Neoplasms With Cc","code_information":[{"code":"181","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9088.75,"maximum":24145.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18904.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9270.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13579.21},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20449.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":20541.78},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15515.58},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":15515.58},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":20541.78},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9088.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":17646.87},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":24145.7},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9270.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9179.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9179.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19995.46},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":9088.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20884.5},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15043.27},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":20884.5},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9179.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9543.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9452.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9179.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":1590.0,"10th_percentile":1590.0,"90th_percentile":1590.0,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":20415.65,"10th_percentile":20415.65,"90th_percentile":20415.65,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20250.76,"10th_percentile":20250.76,"90th_percentile":20250.76,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15304.38,"10th_percentile":15304.38,"90th_percentile":15304.38,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7804.38,"10th_percentile":7804.38,"90th_percentile":7804.38,"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":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17406.17,"10th_percentile":17406.17,"90th_percentile":17406.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":560.9,"10th_percentile":417.79,"90th_percentile":8367.72,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":6570.27,"maximum":16994.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13666.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6701.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9557.43},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14783.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":12732.3,"maximum":34491.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26483.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12986.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19397.6},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28647.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":29343.48},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22163.66},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":22163.66},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":29343.48},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12732.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":25208.16},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":34491.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12986.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12859.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12859.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":28563.08},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":12732.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29833.05},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21488.98},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":29833.05},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12859.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13368.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13241.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12859.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"1 through 10","median_amount":21279.6,"10th_percentile":21279.6,"90th_percentile":21279.6},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":28235.95,"10th_percentile":28235.95,"90th_percentile":28235.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23659.5,"10th_percentile":23659.5,"90th_percentile":23659.5,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":902.24,"10th_percentile":597.28,"90th_percentile":12411.03,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":700.0,"10th_percentile":700.0,"90th_percentile":700.0,"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":"Major Chest Trauma With Cc","code_information":[{"code":"184","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9033.97,"maximum":23990.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18790.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9214.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13491.72},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20326.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":20409.44},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15415.62},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":15415.62},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":20409.44},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9033.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":17533.18},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":23990.13},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9214.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9124.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9124.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19866.64},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":9033.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20749.95},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14946.35},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":20749.95},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9124.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9485.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9395.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9124.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":17815.22,"10th_percentile":17815.22,"90th_percentile":17815.22,"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":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":557.29,"10th_percentile":557.29,"90th_percentile":557.29,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":8017.48,"10th_percentile":8017.48,"90th_percentile":8017.48,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16744.6,"10th_percentile":16744.6,"90th_percentile":16744.6,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":188.78,"10th_percentile":188.78,"90th_percentile":431.92,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":401.91,"10th_percentile":401.91,"90th_percentile":8098.35,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":6829.89,"maximum":17731.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14206.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6966.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9972.03},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15367.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14683.88},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":6829.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15336.75},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11047.18},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":15336.75},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6898.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7171.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7103.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6898.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":9586.02,"10th_percentile":9586.02,"90th_percentile":9586.02,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":5438.46,"10th_percentile":5438.46,"90th_percentile":5438.46,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":6424.14,"10th_percentile":6424.14,"90th_percentile":6424.14,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":5993.81,"10th_percentile":5993.81,"90th_percentile":5993.81,"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":"Pleural Effusion With Mcc","code_information":[{"code":"186","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12959.37,"maximum":35136.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26955.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13218.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19760.22},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29158.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":29892.03},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22577.99},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":22577.99},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":29892.03},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12959.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":25679.4},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":35136.38},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13218.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13088.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13088.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29097.04},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":12959.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":30390.75},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21890.69},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":30390.75},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13088.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13607.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13477.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13088.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":638.92,"10th_percentile":638.92,"90th_percentile":16467.62,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22744.75,"10th_percentile":22744.75,"90th_percentile":22744.75,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":10807.65,"10th_percentile":594.53,"90th_percentile":11676.18,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1153.64,"10th_percentile":594.53,"90th_percentile":13336.28,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":12137.93,"10th_percentile":12137.93,"90th_percentile":12137.93,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"1 through 10","median_amount":594.53,"10th_percentile":594.53,"90th_percentile":594.53,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":594.53,"10th_percentile":594.53,"90th_percentile":594.53,"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."}]}]},{"description":"Pleural Effusion With Cc","code_information":[{"code":"187","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8438.49,"maximum":22299.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17552.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8607.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12540.8},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18986.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":18970.94},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14329.09},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":14329.09},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":18970.94},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8438.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":16297.4},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":22299.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8607.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8522.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8522.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18466.4},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":8438.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19287.45},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13892.9},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":19287.45},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8522.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8860.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8776.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8522.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":518.01,"10th_percentile":377.79,"90th_percentile":7999.38,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10591.77,"10th_percentile":10591.77,"90th_percentile":10591.77,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19111.39,"10th_percentile":19111.39,"90th_percentile":19111.39,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":7597.15,"10th_percentile":7597.15,"90th_percentile":7597.15,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":377.79,"10th_percentile":377.79,"90th_percentile":6159.73,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":7531.4,"10th_percentile":518.01,"90th_percentile":7941.96,"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."}]}]},{"description":"Pleural Effusion Without Cc/Mcc","code_information":[{"code":"188","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6279.67,"maximum":16169.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13061.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6405.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9093.38},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14129.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":13755.9},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10390.08},{"payer_name":"Blue Cross","plan_name":"Health Options - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":10394.04,"maximum":27852.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21619.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10601.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15663.64},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23386.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":23694.97},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17897.24},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":17897.24},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":23694.97},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10394.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":20355.69},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":27852.09},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10601.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10497.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10497.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"1 through 10","median_amount":4276.01,"10th_percentile":4276.01,"90th_percentile":4276.01,"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: 102% of Medicare]","count":"26","median_amount":550.0,"10th_percentile":465.62,"90th_percentile":9857.94,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8494.93,"10th_percentile":8494.93,"90th_percentile":8494.93,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"1 through 10","median_amount":14344.18,"10th_percentile":14344.18,"90th_percentile":14344.18},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":9033.44,"10th_percentile":9033.44,"90th_percentile":9033.44},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":16470.8,"10th_percentile":16470.8,"90th_percentile":16470.8,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22568.94,"10th_percentile":22568.94,"90th_percentile":22568.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":465.62,"10th_percentile":465.62,"90th_percentile":465.62,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":35196.54,"10th_percentile":35196.54,"90th_percentile":73342.32},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"1 through 10","median_amount":4566.62,"10th_percentile":4566.62,"90th_percentile":4566.62,"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":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":825.32,"10th_percentile":825.32,"90th_percentile":825.32,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"19","median_amount":647.01,"10th_percentile":465.62,"90th_percentile":9376.12,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_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":4151.47,"10th_percentile":4151.47,"90th_percentile":4151.47,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":4531.76,"10th_percentile":4531.76,"90th_percentile":4531.76,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"19","median_amount":4151.47,"10th_percentile":2261.77,"90th_percentile":4580.58,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22504.59,"10th_percentile":22504.59,"90th_percentile":22504.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12148.0,"10th_percentile":12148.0,"90th_percentile":12148.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"16","median_amount":500.38,"10th_percentile":277.61,"90th_percentile":9280.21,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":9280.21,"10th_percentile":9280.21,"90th_percentile":107657.06,"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."}]}]},{"description":"Chronic Obstructive Pulmonary Disease With Mcc","code_information":[{"code":"190","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9380.14,"maximum":24973.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19510.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9567.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14044.53},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21105.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":21245.69},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16047.25},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":16047.25},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":21245.69},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9380.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":18251.57},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":24973.1},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9567.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9473.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9473.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20680.65},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":9380.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21600.15},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15558.75},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":21600.15},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9473.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9849.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9755.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9473.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":1133.21,"10th_percentile":1133.21,"90th_percentile":1133.21,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":422.57,"10th_percentile":422.57,"90th_percentile":8460.02,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14238.52,"10th_percentile":14238.52,"90th_percentile":14238.52,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":12981.39,"10th_percentile":12981.39,"90th_percentile":12981.39},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":20424.53,"10th_percentile":20424.53,"90th_percentile":20424.53,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15479.43,"10th_percentile":15479.43,"90th_percentile":15479.43,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":6602.99,"10th_percentile":422.57,"90th_percentile":8749.69,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18386.71,"10th_percentile":18386.71,"90th_percentile":18386.71,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":28740.89,"10th_percentile":28740.89,"90th_percentile":28740.89},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":8396.57,"10th_percentile":454.11,"90th_percentile":8458.88,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"41","median_amount":454.11,"10th_percentile":372.87,"90th_percentile":8556.63,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":3054.03,"10th_percentile":3054.03,"90th_percentile":3054.03,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6929.69,"10th_percentile":6929.69,"90th_percentile":6929.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"37","median_amount":454.11,"10th_percentile":422.57,"90th_percentile":8465.64,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"1 through 10","median_amount":454.11,"10th_percentile":454.11,"90th_percentile":5081.4,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":454.11,"10th_percentile":422.57,"90th_percentile":8493.88,"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."}]}]},{"description":"Chronic Obstructive Pulmonary Disease With Cc","code_information":[{"code":"191","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7278.49,"maximum":19005.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15139.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7424.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10688.4},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16376.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":16168.74},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12212.54},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":12212.54},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":16168.74},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7278.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":13890.11},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":19005.44},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7424.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7351.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7351.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15738.73},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":7278.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16438.5},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11840.78},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":16438.5},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7351.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7642.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7569.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7351.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":1531.44,"10th_percentile":1531.44,"90th_percentile":1531.44,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":441.5,"10th_percentile":323.26,"90th_percentile":6921.61,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":1489.53,"10th_percentile":1489.53,"90th_percentile":1489.53},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":15905.48,"10th_percentile":15905.48,"90th_percentile":15905.48,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17668.24,"10th_percentile":17668.24,"90th_percentile":17668.24,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15669.12,"10th_percentile":15669.12,"90th_percentile":15669.12,"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":"Blue Cross","plan_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":323.26,"10th_percentile":323.26,"90th_percentile":6525.76,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10654.6,"10th_percentile":10654.6,"90th_percentile":10654.6,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"15","median_amount":441.5,"10th_percentile":323.26,"90th_percentile":6564.49,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":3054.03,"10th_percentile":3054.03,"90th_percentile":3054.03,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"12","median_amount":3902.41,"10th_percentile":323.26,"90th_percentile":6836.52,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"1 through 10","median_amount":347.4,"10th_percentile":347.4,"90th_percentile":347.4,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":347.4,"10th_percentile":347.4,"90th_percentile":347.4,"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."}]}]},{"description":"Chronic Obstructive Pulmonary Disease Without Cc/Mcc","code_information":[{"code":"192","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5682.6,"maximum":14473.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11819.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5796.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8139.92},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12785.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":12313.56},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9300.65},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":9300.65},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":12313.56},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5682.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":10578.23},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":14473.89},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5796.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5739.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5739.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11986.08},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":5682.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12519.0},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9017.53},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":12519.0},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5739.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5966.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5909.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5739.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":5685.33,"10th_percentile":5685.33,"90th_percentile":5685.33,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7421.0,"10th_percentile":7421.0,"90th_percentile":7421.0,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":243.53,"10th_percentile":243.53,"90th_percentile":5040.09,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":261.71,"10th_percentile":261.71,"90th_percentile":261.71,"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."}]}]},{"description":"Simple Pneumonia And Pleurisy With Mcc","code_information":[{"code":"193","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11021.28,"maximum":29633.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22924.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11241.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16665.28},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24797.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":25210.19},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19041.71},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":19041.71},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":25210.19},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11021.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":21657.37},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":29633.15},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11241.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11131.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11131.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":24539.72},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":11021.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25630.8},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18462.06},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":25630.8},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11131.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11572.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11462.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11131.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":72882.5,"10th_percentile":20623.26,"90th_percentile":72882.5,"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":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"69","median_amount":500.0,"10th_percentile":495.83,"90th_percentile":10437.83,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20713.31,"10th_percentile":20713.31,"90th_percentile":20713.31,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":11681.41,"10th_percentile":11681.41,"90th_percentile":11681.41},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":23979.67,"10th_percentile":23849.24,"90th_percentile":24641.89,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23233.53,"10th_percentile":21523.5,"90th_percentile":24033.53,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16969.68,"10th_percentile":12282.03,"90th_percentile":28250.17,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18163.18,"10th_percentile":18163.18,"90th_percentile":45519.39,"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":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"18","median_amount":532.85,"10th_percentile":495.83,"90th_percentile":9652.6,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20057.58,"10th_percentile":18686.82,"90th_percentile":20657.58,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19357.55,"10th_percentile":19357.55,"90th_percentile":19357.55,"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":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":44791.35,"10th_percentile":44791.35,"90th_percentile":72594.71},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_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":495.83,"10th_percentile":495.83,"90th_percentile":532.85,"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":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":9874.24,"10th_percentile":495.83,"90th_percentile":9874.74,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"102","median_amount":688.38,"10th_percentile":495.83,"90th_percentile":10206.92,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_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":7087.2,"10th_percentile":7087.2,"90th_percentile":7087.2,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":7921.72,"10th_percentile":7921.72,"90th_percentile":8702.85,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"18","median_amount":7921.72,"10th_percentile":3623.01,"90th_percentile":8369.15,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20895.15,"10th_percentile":2952.54,"90th_percentile":72376.01,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16988.38,"10th_percentile":16988.38,"90th_percentile":16988.38,"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":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"89","median_amount":688.38,"10th_percentile":495.83,"90th_percentile":9909.99,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"1 through 10","median_amount":688.38,"10th_percentile":495.83,"90th_percentile":41627.3,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"21","median_amount":495.83,"10th_percentile":371.87,"90th_percentile":9876.24,"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."}]}]},{"description":"Simple Pneumonia And Pleurisy With Cc","code_information":[{"code":"194","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6983.93,"maximum":18169.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14526.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7123.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10218.01},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15713.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":15457.16},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11675.07},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":11675.07},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":15457.16},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6983.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":13278.81},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":18169.02},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7123.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7053.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7053.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15046.07},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":6983.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15715.05},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11319.67},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":15715.05},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7053.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7333.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7263.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7053.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":13209.93,"10th_percentile":13209.93,"90th_percentile":13209.93,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":18387.2,"10th_percentile":18387.2,"90th_percentile":18387.2},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"32","median_amount":422.07,"10th_percentile":308.55,"90th_percentile":6636.1,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"1 through 10","median_amount":11430.6,"10th_percentile":11430.6,"90th_percentile":11430.6},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":16541.51,"10th_percentile":16541.51,"90th_percentile":16541.51},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":15346.96,"10th_percentile":15209.53,"90th_percentile":15427.06,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12605.14,"10th_percentile":11964.8,"90th_percentile":14919.22,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11302.88,"10th_percentile":5302.88,"90th_percentile":11302.88,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"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":422.07,"10th_percentile":308.55,"90th_percentile":6522.69,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12627.13,"10th_percentile":10934.9,"90th_percentile":17579.98,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"1 through 10","median_amount":3466.3,"10th_percentile":3466.3,"90th_percentile":3466.3,"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":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"29","median_amount":446.88,"10th_percentile":308.55,"90th_percentile":6543.14,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_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":3466.3,"10th_percentile":3466.3,"90th_percentile":3466.3,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":3767.47,"10th_percentile":2280.46,"90th_percentile":6713.53,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14913.34,"10th_percentile":14913.34,"90th_percentile":14913.34,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2128.94,"10th_percentile":2128.94,"90th_percentile":2128.94,"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":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"57","median_amount":422.07,"10th_percentile":308.55,"90th_percentile":6288.51,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"13","median_amount":422.07,"10th_percentile":308.55,"90th_percentile":6299.11,"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."}]}]},{"description":"Simple Pneumonia And Pleurisy Without Cc/Mcc","code_information":[{"code":"195","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5575.42,"maximum":14169.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11596.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5686.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":7968.75},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12544.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":12054.63},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9105.08},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":9105.08},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":12054.63},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5575.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":10355.79},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":14169.53},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5686.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5631.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5631.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11734.03},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":5575.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12255.75},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8827.91},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":12255.75},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5631.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5854.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5798.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5631.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":11817.71,"10th_percentile":11817.71,"90th_percentile":11817.71,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":234.31,"10th_percentile":234.31,"90th_percentile":4934.62,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7895.21,"10th_percentile":7895.21,"90th_percentile":7895.21,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12143.88,"10th_percentile":12143.88,"90th_percentile":12143.88,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8115.64,"10th_percentile":8115.64,"90th_percentile":8115.64,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":4219.19,"10th_percentile":234.31,"90th_percentile":4420.48,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6585.01,"10th_percentile":6585.01,"90th_percentile":6585.01,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"18","median_amount":581.13,"10th_percentile":234.31,"90th_percentile":4925.7,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_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":1738.38,"10th_percentile":1738.38,"90th_percentile":1738.38,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":1738.38,"10th_percentile":1419.54,"90th_percentile":1825.16,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11325.04,"10th_percentile":11325.04,"90th_percentile":11325.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2803.04,"10th_percentile":2803.04,"90th_percentile":2803.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11325.04,"10th_percentile":11325.04,"90th_percentile":11325.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":329.16,"10th_percentile":234.31,"90th_percentile":5570.02,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":4889.41,"10th_percentile":4889.41,"90th_percentile":4889.41,"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."}]}]},{"description":"Interstitial Lung Disease With Mcc","code_information":[{"code":"196","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15569.17,"maximum":42546.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32383.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15880.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":23927.81},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35030.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23588.84,"10th_percentile":23588.84,"90th_percentile":23588.84,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":13370.1,"10th_percentile":708.96,"90th_percentile":13841.6,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":11450.01,"10th_percentile":11450.01,"90th_percentile":11450.01,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1869.96,"10th_percentile":988.37,"90th_percentile":14553.12,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":548.03,"10th_percentile":548.03,"90th_percentile":548.03,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"12","median_amount":980.61,"10th_percentile":708.96,"90th_percentile":12495.94,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":13942.99,"10th_percentile":13942.99,"90th_percentile":13942.99,"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."}]}]},{"description":"Interstitial Lung Disease With Cc","code_information":[{"code":"197","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8120.9,"maximum":21397.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16891.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8283.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12033.64},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18272.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":18203.74},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13749.61},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":13749.61},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":18203.74},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8120.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":15638.32},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":21397.46},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8283.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8202.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8202.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17719.6},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":8120.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18507.45},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13331.06},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":18507.45},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8202.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8526.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8445.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8202.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_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":400.33,"10th_percentile":400.33,"90th_percentile":400.33,"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":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":372.53,"10th_percentile":372.53,"90th_percentile":7496.96,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":497.07,"10th_percentile":497.07,"90th_percentile":6199.64,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":6271.73,"maximum":16146.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13045.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6397.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9080.7},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14111.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":13736.72},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10375.59},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":10375.59},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":13736.72},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6271.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":11800.83},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":16146.73},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6397.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6334.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6334.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":14591.78,"maximum":39771.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30350.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14883.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22367.02},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32831.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":32935.57},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":14591.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":34399.95},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24778.55},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":34399.95},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14737.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15321.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15175.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14737.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26048.62,"10th_percentile":26048.62,"90th_percentile":26048.62,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_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":664.25,"10th_percentile":664.25,"90th_percentile":664.25,"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":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":923.89,"10th_percentile":923.89,"90th_percentile":13089.77,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":8349.59,"10th_percentile":664.25,"90th_percentile":13837.46,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":17837.15,"10th_percentile":17837.15,"90th_percentile":17837.15,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":13099.65,"10th_percentile":923.89,"90th_percentile":13697.12,"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":"Pneumothorax With Cc","code_information":[{"code":"200","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9313.45,"maximum":24783.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19371.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9499.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13938.02},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20955.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":21084.57},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15925.56},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":15925.56},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":21084.57},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9313.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":18113.17},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":24783.72},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9499.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9406.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9406.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20523.82},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":9313.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21436.35},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15440.77},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":21436.35},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9406.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9779.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9685.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9406.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":575.73,"10th_percentile":575.73,"90th_percentile":8847.44,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":8180.27,"10th_percentile":8180.27,"90th_percentile":8180.27,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15213.64,"10th_percentile":15213.64,"90th_percentile":16612.28,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":447.85,"10th_percentile":447.85,"90th_percentile":8345.02,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":4531.76,"10th_percentile":4531.76,"90th_percentile":4531.76,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8823.3,"10th_percentile":8823.3,"90th_percentile":8823.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":6651.61,"10th_percentile":447.85,"90th_percentile":6855.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Pneumothorax Without Cc/Mcc","code_information":[{"code":"201","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6263.0,"maximum":16121.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13027.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6388.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9066.75},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14091.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":13715.62},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10359.65},{"payer_name":"Blue Cross","plan_name":"Health Options - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":2087.78,"10th_percentile":2087.78,"90th_percentile":2087.78,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":5259.76,"10th_percentile":5259.76,"90th_percentile":5259.76,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":5291.36,"10th_percentile":5291.36,"90th_percentile":5291.36,"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."}]}]},{"description":"Bronchitis And Asthma With Cc/Mcc","code_information":[{"code":"202","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8296.36,"maximum":21895.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17256.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8462.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12313.84},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18666.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":18627.62},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14069.77},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":14069.77},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":18627.62},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8296.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":16002.46},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":21895.7},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8462.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8379.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8379.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18132.21},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":8296.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18938.4},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13641.48},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":18938.4},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8379.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8711.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8628.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8379.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":363.76,"10th_percentile":363.76,"90th_percentile":7419.93,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":33894.61,"10th_percentile":33894.61,"90th_percentile":33894.61},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":18509.83,"10th_percentile":17621.71,"90th_percentile":18985.01,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14779.98,"10th_percentile":12424.63,"90th_percentile":18792.79,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11590.99,"10th_percentile":11590.99,"90th_percentile":12124.99,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":7293.75,"10th_percentile":7293.75,"90th_percentile":7293.75,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15154.96,"10th_percentile":14554.96,"90th_percentile":15154.96,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_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":508.64,"10th_percentile":508.64,"90th_percentile":508.64,"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":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"1 through 10","median_amount":2792.7,"10th_percentile":2792.7,"90th_percentile":2792.7,"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":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":363.76,"10th_percentile":363.76,"90th_percentile":18441.36,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_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":2811.72,"10th_percentile":2811.72,"90th_percentile":2811.72,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":7087.2,"10th_percentile":3157.14,"90th_percentile":7087.2,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"16","median_amount":3699.54,"10th_percentile":2811.72,"90th_percentile":7087.2,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6077.03,"10th_percentile":6077.03,"90th_percentile":6077.03,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"21","median_amount":363.76,"10th_percentile":363.76,"90th_percentile":7357.75,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"1 through 10","median_amount":363.76,"10th_percentile":363.76,"90th_percentile":7782.96,"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: 104% of Medicare]","count":"1 through 10","median_amount":5529.28,"10th_percentile":390.91,"90th_percentile":7211.66,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":395.0,"10th_percentile":363.76,"90th_percentile":7364.74,"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."}]}]},{"description":"Bronchitis And Asthma Without Cc/Mcc","code_information":[{"code":"203","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5904.92,"maximum":15105.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12282.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6023.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8494.93},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13286.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10920.6,"10th_percentile":10920.6,"90th_percentile":12705.29,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9777.98,"10th_percentile":9601.93,"90th_percentile":32853.0,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":15106.01,"10th_percentile":15106.01,"90th_percentile":15106.01},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"1 through 10","median_amount":2177.54,"10th_percentile":2177.54,"90th_percentile":2177.54,"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":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_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":1689.85,"10th_percentile":1689.85,"90th_percentile":1689.85,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":1689.85,"10th_percentile":1689.85,"90th_percentile":1689.85,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":2123.73,"10th_percentile":2123.73,"90th_percentile":3157.14,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":6995.84,"maximum":18202.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14551.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7135.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10237.02},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15740.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":4955.0,"10th_percentile":4955.0,"90th_percentile":4955.0,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":14864.81,"10th_percentile":14864.81,"90th_percentile":14864.81,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10800.03,"10th_percentile":10800.03,"90th_percentile":10800.03,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11178.82,"10th_percentile":11178.82,"90th_percentile":11178.82,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":327.95,"10th_percentile":327.95,"90th_percentile":5026.38,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12714.05,"10th_percentile":12714.05,"90th_percentile":12714.05,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":18071.06,"10th_percentile":18071.06,"90th_percentile":18071.06},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":6213.88,"10th_percentile":6213.88,"90th_percentile":6213.88,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15744.3,"10th_percentile":15744.3,"90th_percentile":15744.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":6242.51,"10th_percentile":6242.51,"90th_percentile":6242.51,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":6246.89,"10th_percentile":6246.89,"90th_percentile":6246.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Other Respiratory System Diagnoses With Mcc","code_information":[{"code":"205","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15122.95,"maximum":41279.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31455.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15425.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":23215.25},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34026.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":35118.58},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26525.7},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":26525.7},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":35118.58},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15122.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":30169.39},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":41279.9},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15425.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15274.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15274.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":34184.59},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":15122.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":35704.5},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25718.23},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":35704.5},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15274.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15879.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15727.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15274.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":1446.48,"10th_percentile":1446.48,"90th_percentile":1446.48,"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":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":763.38,"10th_percentile":710.35,"90th_percentile":13948.99,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":34752.92,"10th_percentile":34752.92,"90th_percentile":34752.92,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":24121.53,"10th_percentile":24121.53,"90th_percentile":24121.53},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":6553.72,"10th_percentile":710.35,"90th_percentile":13917.55,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_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":4621.31,"10th_percentile":4621.31,"90th_percentile":4621.31,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":2068.0,"10th_percentile":710.35,"90th_percentile":12126.75,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":2100.0,"10th_percentile":763.38,"90th_percentile":13997.82,"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."}]}]},{"description":"Other Respiratory System Diagnoses Without Mcc","code_information":[{"code":"206","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8057.38,"maximum":21217.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16759.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8218.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11932.21},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18129.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":18050.3},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13633.72},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":13633.72},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":18050.3},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8057.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":15506.5},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":21217.1},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8218.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8137.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8137.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17570.24},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":8057.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18351.45},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13218.69},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":18351.45},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8137.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8460.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8379.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8137.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":15134.89,"10th_percentile":15134.89,"90th_percentile":15896.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":492.87,"10th_percentile":366.28,"90th_percentile":7561.24,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":9701.2,"10th_percentile":9701.2,"90th_percentile":9701.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":22409.25,"maximum":61969.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":46611.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22857.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":34850.77},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":50420.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":14715.83,"10th_percentile":14715.83,"90th_percentile":14715.83},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":44592.94,"10th_percentile":44592.94,"90th_percentile":44592.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":19943.8,"10th_percentile":19943.8,"90th_percentile":19943.8,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":39890.76,"10th_percentile":39890.76,"90th_percentile":39890.76,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":19681.56,"10th_percentile":1009.87,"90th_percentile":19688.25,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":8561.69,"10th_percentile":1009.87,"90th_percentile":24179.75,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":19276.35,"10th_percentile":19276.35,"90th_percentile":19276.35,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":4210.44,"10th_percentile":4210.44,"90th_percentile":4210.44,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"12","median_amount":17996.44,"10th_percentile":1009.87,"90th_percentile":20065.93,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1439.55,"10th_percentile":1200.0,"90th_percentile":41946.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Complex Aortic Arch Procedures","code_information":[{"code":"209","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":90453.61,"maximum":255182.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":188143.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":92262.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":143511.07},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":203520.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":217094.58},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":163975.46},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":163975.46},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":217094.58},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90453.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":186499.87},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":255182.35},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":92262.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":91358.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":91358.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":211320.86},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":90453.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":220716.6},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":158983.86},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":220716.6},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":91358.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":94976.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":94071.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":91358.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":84739.93,"10th_percentile":84739.93,"90th_percentile":84739.93,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":86922.81,"maximum":245156.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":180799.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":88661.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":137872.71},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":195576.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":208565.24},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":157533.09},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":157533.09},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":208565.24},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":86922.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":179172.55},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":245156.58},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":88661.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":87792.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":87792.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":203018.36},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":86922.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":212044.95},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":152737.61},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":212044.95},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":87792.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":91268.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90399.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":87792.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":82120.41,"10th_percentile":82120.41,"90th_percentile":82120.41,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":45896.59,"maximum":128662.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":95464.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46814.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":72357.79},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":103267.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":109458.34},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":82675.86},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":82675.86},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":109458.34},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45896.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":94032.59},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":128662.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46814.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46355.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46355.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":106547.25},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":45896.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":111284.55},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":80159.12},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":111284.55},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46355.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48191.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47732.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46355.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":42821.63,"10th_percentile":42821.63,"90th_percentile":42821.63,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":79641.27,"maximum":224480.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":165653.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81234.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":126244.8},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":179192.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":190975.26},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":144247.06},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":144247.06},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":190975.26},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":79641.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":164061.49},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":224480.57},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81234.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80437.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80437.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":381913.57,"10th_percentile":381913.57,"90th_percentile":381913.57,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":157196.52,"10th_percentile":157196.52,"90th_percentile":157196.52,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"1 through 10","median_amount":140236.71,"10th_percentile":140236.71,"90th_percentile":140236.71},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":75689.66,"10th_percentile":4284.31,"90th_percentile":76461.39,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":4284.31,"10th_percentile":3986.67,"90th_percentile":74244.28,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":76093.91,"10th_percentile":76093.91,"90th_percentile":76093.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"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":78258.17,"maximum":220553.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":162776.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":79823.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":124036.12},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":176080.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":179617.79,"10th_percentile":179617.79,"90th_percentile":180071.48,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":68769.67,"10th_percentile":3902.69,"90th_percentile":72929.35,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":28298.04,"10th_percentile":28298.04,"90th_percentile":28298.04,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":192362.56,"10th_percentile":192362.56,"90th_percentile":192362.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":5123.46,"10th_percentile":3631.57,"90th_percentile":69413.29,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":3902.69,"10th_percentile":2450.0,"90th_percentile":73154.37,"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."}]}]},{"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":52791.46,"maximum":148240.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":109806.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53847.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":83368.23},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":118780.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":127047.95,"10th_percentile":127047.95,"90th_percentile":127047.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":95959.93,"10th_percentile":95959.93,"90th_percentile":95959.93,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":44197.3,"10th_percentile":44197.3,"90th_percentile":44197.3,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1950.0,"10th_percentile":1950.0,"90th_percentile":1950.0,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":3443.62,"10th_percentile":3443.62,"90th_percentile":46711.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"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":52791.46,"maximum":148240.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":109806.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53847.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":83368.23},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":118780.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":126114.25},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":95256.37},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":95256.37},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":126114.25},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52791.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":108341.22},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":148240.14},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53847.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53319.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53319.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":122760.19},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":52791.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":128218.35},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":92356.66},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":128218.35},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53319.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55431.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54903.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53319.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":93797.29,"10th_percentile":93797.29,"90th_percentile":93797.29,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":61548.99,"maximum":173107.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":128021.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62779.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":97353.17},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":138485.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":143353.09},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":61548.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":149726.85},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":107849.4},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":149726.85},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62164.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64626.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64010.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62164.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":116385.61,"10th_percentile":116385.61,"90th_percentile":116385.61,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"1 through 10","median_amount":16405.48,"10th_percentile":16405.48,"90th_percentile":16405.48,"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] [MSDRG Base Rate: 102% of Medicare]","count":"1 through 10","median_amount":44950.2,"10th_percentile":2312.03,"90th_percentile":55967.04,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":134899.16,"10th_percentile":134899.16,"90th_percentile":134899.16,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":194601.33,"10th_percentile":194601.33,"90th_percentile":194601.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":106653.7,"10th_percentile":106653.7,"90th_percentile":106653.7,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":106653.7,"10th_percentile":106653.7,"90th_percentile":106653.7,"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":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":43148.7,"10th_percentile":2911.51,"90th_percentile":54044.66,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":87363.43,"10th_percentile":87363.43,"90th_percentile":87363.43},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"1 through 10","median_amount":99673.23,"10th_percentile":99673.23,"90th_percentile":99673.23},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":3128.88,"10th_percentile":2911.51,"90th_percentile":64856.93,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":140721.91,"10th_percentile":140721.91,"90th_percentile":140721.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":97076.55,"10th_percentile":97076.55,"90th_percentile":97076.55,"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":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":3128.88,"10th_percentile":2911.51,"90th_percentile":56292.89,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":47810.92,"10th_percentile":2825.91,"90th_percentile":56003.99,"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."}]}]},{"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":42926.33,"maximum":120227.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":89286.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43784.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":67614.57},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":96584.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":102283.1},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":77256.27},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":77256.27},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":102283.1},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42926.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":87868.55},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":120227.98},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43784.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43355.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43355.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":99562.84},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":42926.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":103989.6},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":74904.51},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":103989.6},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43355.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45072.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44643.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43355.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":80745.2,"10th_percentile":80745.2,"90th_percentile":80745.2,"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":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"31","median_amount":2141.87,"10th_percentile":1650.0,"90th_percentile":38833.29,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":89598.65,"10th_percentile":89598.65,"90th_percentile":89598.65},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":85556.45,"10th_percentile":85556.45,"90th_percentile":85556.45,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":103040.36,"10th_percentile":96606.51,"90th_percentile":120197.8,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":77826.88,"10th_percentile":77826.88,"90th_percentile":77826.88,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":36473.69,"10th_percentile":1993.07,"90th_percentile":37398.69,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":88519.15,"10th_percentile":83036.37,"90th_percentile":88519.15,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":105441.89,"10th_percentile":105441.89,"90th_percentile":105441.89},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"1 through 10","median_amount":90109.91,"10th_percentile":90109.91,"90th_percentile":90109.91},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"16","median_amount":2689.56,"10th_percentile":1993.07,"90th_percentile":39080.82,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3069.73,"10th_percentile":3069.73,"90th_percentile":3069.73,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":71881.52,"10th_percentile":71881.52,"90th_percentile":71881.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":38433.85,"10th_percentile":1993.07,"90th_percentile":39764.58,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"11","median_amount":2792.9,"10th_percentile":1886.25,"90th_percentile":38482.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"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":40603.16,"maximum":113631.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":84454.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41415.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":63904.7},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":91357.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":96671.04},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":73017.38},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":73017.38},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":96671.04},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40603.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":83047.38},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":113631.31},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41415.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41009.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41009.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":94100.03},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":40603.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":98283.9},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":70794.65},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":98283.9},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41009.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42633.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42227.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41009.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":27244.28,"10th_percentile":27244.28,"90th_percentile":27244.28,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":39866.35,"maximum":111539.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":82922.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40663.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":62728.08},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":89699.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":94891.13},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":71672.98},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":71672.98},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":94891.13},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39866.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":81518.31},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":111539.13},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40663.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40265.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40265.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":92367.46},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":39866.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":96474.3},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":69491.18},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":96474.3},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40265.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41859.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41461.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40265.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":36575.67,"10th_percentile":1875.14,"90th_percentile":37693.84,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":90890.41,"10th_percentile":90890.41,"90th_percentile":90890.41,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":34640.96,"10th_percentile":1875.14,"90th_percentile":35961.83,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":35720.59,"10th_percentile":2015.13,"90th_percentile":36116.68,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":2015.13,"10th_percentile":1875.14,"90th_percentile":34941.64,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"1 through 10","median_amount":35592.07,"10th_percentile":35592.07,"90th_percentile":35592.07,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":36207.41,"10th_percentile":2591.06,"90th_percentile":37301.58,"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."}]}]},{"description":"Other Cardiothoracic Procedures Without Mcc","code_information":[{"code":"229","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25591.5,"maximum":71005.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":53230.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26103.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":39932.51},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":57580.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":60407.41},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45626.81},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":45626.81},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":60407.41},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25591.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":51894.31},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":71005.48},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26103.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25847.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25847.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":42817.24,"10th_percentile":42817.24,"90th_percentile":42817.24,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":22234.93,"10th_percentile":22234.93,"90th_percentile":22234.93,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":48697.47,"10th_percentile":48697.47,"90th_percentile":48697.47,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":23970.11,"10th_percentile":23970.11,"90th_percentile":23970.11,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1649.46,"10th_percentile":1168.86,"90th_percentile":23864.8,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":56494.28,"10th_percentile":56494.28,"90th_percentile":56494.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"14","median_amount":1649.46,"10th_percentile":1168.86,"90th_percentile":23940.07,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"14","median_amount":22478.65,"10th_percentile":1168.86,"90th_percentile":22725.94,"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."}]}]},{"description":"Coronary Bypass With Ptca With Mcc","code_information":[{"code":"231","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":67516.5,"maximum":190052.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":140434.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68866.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":106882.7},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":151912.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":161685.48},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":122123.96},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":122123.96},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":161685.48},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67516.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":138899.46},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":190052.1},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68866.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68191.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68191.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":157385.39},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":67516.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":164383.05},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":118406.38},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":164383.05},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68191.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70892.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70217.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68191.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":254618.96,"10th_percentile":254618.96,"90th_percentile":254618.96,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":48720.75,"maximum":136681.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":101339.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49695.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":76867.71},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":109621.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":116280.67},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":87828.89},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":87828.89},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":116280.67},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48720.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":99893.46},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":136681.32},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49695.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49207.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49207.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":113188.14},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":48720.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":118220.7},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":85155.28},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":118220.7},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49207.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51156.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50669.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49207.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":61286.18,"maximum":172361.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":127475.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62511.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":96933.49},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":137893.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":146634.94},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":110756.01},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":110756.01},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":146634.94},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61286.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":125969.96},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":172361.03},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62511.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61899.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61899.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":2342.66,"10th_percentile":1740.0,"90th_percentile":56533.3,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":62510.84,"10th_percentile":62510.84,"90th_percentile":62510.84,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":108755.8,"10th_percentile":108755.8,"90th_percentile":120802.37,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":194272.19,"10th_percentile":194272.19,"90th_percentile":195565.06,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":120697.19,"10th_percentile":120697.19,"90th_percentile":173224.38,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":56207.81,"10th_percentile":56207.81,"90th_percentile":56207.81,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":122537.7,"10th_percentile":122537.7,"90th_percentile":132897.35,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":38503.39,"10th_percentile":2602.96,"90th_percentile":57667.3,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":211086.74,"10th_percentile":211086.74,"90th_percentile":211086.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":109789.15,"10th_percentile":109789.15,"90th_percentile":109789.15,"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":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":34294.68,"10th_percentile":2237.83,"90th_percentile":55797.3,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":19116.56,"10th_percentile":1822.07,"90th_percentile":57357.71,"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."}]}]},{"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":43957.7,"maximum":123156.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":91432.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44836.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":69261.57},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98904.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":104774.59},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":79138.13},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":79138.13},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":104774.59},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43957.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":90008.91},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":123156.57},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44836.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44397.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44397.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":101988.06},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":43957.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":106522.65},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":76729.08},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":106522.65},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44397.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46155.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45716.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44397.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":69495.71,"10th_percentile":50403.83,"90th_percentile":82118.72,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":29029.43,"10th_percentile":1859.22,"90th_percentile":39675.66,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"1 through 10","median_amount":94035.56,"10th_percentile":94035.56,"90th_percentile":94035.56},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":93668.4,"10th_percentile":93668.4,"90th_percentile":93668.4,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":95285.13,"10th_percentile":94866.84,"90th_percentile":102473.83,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":91092.3,"10th_percentile":91092.3,"90th_percentile":91092.3,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":72583.64,"10th_percentile":72583.64,"90th_percentile":72583.64,"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":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":24516.67,"10th_percentile":2001.91,"90th_percentile":36463.43,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":91169.8,"10th_percentile":91169.8,"90th_percentile":91169.8,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"1 through 10","median_amount":105412.1,"10th_percentile":105412.1,"90th_percentile":105412.1},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_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":2001.91,"10th_percentile":2001.91,"90th_percentile":2001.91,"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":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":38961.93,"10th_percentile":38961.93,"90th_percentile":38961.93,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":2450.0,"10th_percentile":2001.91,"90th_percentile":38528.27,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":96758.48,"10th_percentile":96758.48,"90th_percentile":96758.48,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"13","median_amount":33439.11,"10th_percentile":1977.29,"90th_percentile":39397.63,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"17","median_amount":2124.91,"10th_percentile":1593.52,"90th_percentile":38615.95,"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":"Coronary Bypass Without Cardiac Catheterization With Mcc","code_information":[{"code":"235","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":47180.44,"maximum":132307.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98135.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48124.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":74407.98},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":106155.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":112324.26,"10th_percentile":112324.26,"90th_percentile":112324.26,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":32254.42,"10th_percentile":32254.42,"90th_percentile":32254.42,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":29568.56,"10th_percentile":29568.56,"90th_percentile":29568.56,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":27832.27,"10th_percentile":27832.27,"90th_percentile":27832.27,"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":"Coronary Bypass Without Cardiac Catheterization Without Mcc","code_information":[{"code":"236","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33843.27,"maximum":94436.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":70394.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34520.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":53109.8},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":76147.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":80341.18},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":60683.15},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":60683.15},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":80341.18},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33843.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":69018.86},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":94436.5},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34520.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34181.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34181.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":82802.62,"10th_percentile":82802.62,"90th_percentile":82802.62,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":29565.25,"10th_percentile":29565.25,"90th_percentile":29565.25,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":64465.39,"10th_percentile":64465.39,"90th_percentile":64465.39,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"1 through 10","median_amount":1963.22,"10th_percentile":1963.22,"90th_percentile":1963.22},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":16618.3,"10th_percentile":2193.76,"90th_percentile":29185.52,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":50693.76,"10th_percentile":50693.76,"90th_percentile":50693.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1580.0,"10th_percentile":1547.32,"90th_percentile":1680.0,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":29938.53,"10th_percentile":29938.53,"90th_percentile":29938.53,"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."}]}]},{"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":39662.3,"maximum":110959.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":82497.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40455.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":62402.23},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":89240.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":94398.21},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":71300.67},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":71300.67},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":94398.21},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39662.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":81094.85},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":110959.73},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40455.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40058.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40058.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":91887.65},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":39662.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":95973.15},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":69130.2},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":95973.15},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40058.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41645.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41248.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40058.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":39593.48,"10th_percentile":39593.48,"90th_percentile":39593.48,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":62738.81,"10th_percentile":62738.81,"90th_percentile":62738.81,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":96423.58,"10th_percentile":96423.58,"90th_percentile":96423.58,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1895.31,"10th_percentile":1895.31,"90th_percentile":1895.31,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":91606.1,"10th_percentile":91606.1,"90th_percentile":91606.1,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":35524.71,"10th_percentile":35524.71,"90th_percentile":35524.71,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":23217.52,"maximum":64264.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48292.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23681.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":36141.49},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52239.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":53218.55},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":23217.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":55584.75},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40038.12},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":55584.75},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23449.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24378.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24146.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23449.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":21111.77,"10th_percentile":21111.77,"90th_percentile":21111.77,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":21065.84,"10th_percentile":1177.63,"90th_percentile":22245.38,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":13288.34,"10th_percentile":1095.82,"90th_percentile":20241.68,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":11577.06,"maximum":31211.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24080.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11808.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17552.81},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26048.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":26552.79},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20055.8},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":20055.8},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":26552.79},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11577.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":22810.76},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":31211.3},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11808.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11692.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11692.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25846.61},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":11577.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26995.8},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19445.28},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":26995.8},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11692.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12155.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12040.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11692.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":8319.87,"10th_percentile":8319.87,"90th_percentile":8319.87,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":25935.29,"maximum":71981.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":53945.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26454.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":40481.51},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":58354.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":1672.13,"10th_percentile":1672.13,"90th_percentile":1672.13,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1371.65,"10th_percentile":623.86,"90th_percentile":24445.86,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":8975.89,"10th_percentile":8975.89,"90th_percentile":8975.89,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1353.16,"10th_percentile":1353.16,"90th_percentile":1353.16,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":10045.63,"10th_percentile":1276.36,"90th_percentile":24772.03,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":24521.55,"10th_percentile":24521.55,"90th_percentile":24521.55,"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."}]}]},{"description":"Permanent Cardiac Pacemaker Implant With Cc","code_information":[{"code":"243","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17504.08,"maximum":48041.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36408.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17854.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":27017.68},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39384.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":40870.66},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30870.35},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":30870.35},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":40870.66},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17504.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":35110.84},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":48041.14},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17854.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17679.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17679.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":39783.69},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":17504.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":41552.55},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29930.62},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":41552.55},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17679.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18379.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18204.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17679.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":34821.3,"10th_percentile":34821.3,"90th_percentile":34821.3,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"13","median_amount":847.7,"10th_percentile":847.7,"90th_percentile":16886.59,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33728.0,"10th_percentile":33728.0,"90th_percentile":33728.0,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"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":15710.37,"10th_percentile":847.7,"90th_percentile":16153.15,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34717.15,"10th_percentile":34717.15,"90th_percentile":34717.15,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"1 through 10","median_amount":13059.97,"10th_percentile":13059.97,"90th_percentile":13059.97,"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":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":16570.25,"10th_percentile":16570.25,"90th_percentile":16570.25,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":13336.51,"10th_percentile":910.98,"90th_percentile":16568.59,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":43929.6,"10th_percentile":43929.6,"90th_percentile":43929.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"31","median_amount":1580.0,"10th_percentile":847.7,"90th_percentile":16558.84,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"14","median_amount":3567.11,"10th_percentile":847.7,"90th_percentile":16562.23,"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."}]}]},{"description":"Permanent Cardiac Pacemaker Implant Without Cc/Mcc","code_information":[{"code":"244","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14936.37,"maximum":40750.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31067.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15235.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22917.29},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33606.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":34667.85},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26185.25},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":26185.25},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":34667.85},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14936.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":29782.18},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":40750.09},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15235.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15085.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15085.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":33745.84},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":14936.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":35246.25},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25388.15},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":35246.25},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15085.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15683.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15533.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15085.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":27937.4,"10th_percentile":27937.4,"90th_percentile":27937.4,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":13369.99,"10th_percentile":695.05,"90th_percentile":13507.7,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22917.29,"10th_percentile":22917.29,"90th_percentile":22917.29,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"1 through 10","median_amount":24087.67,"10th_percentile":24087.67,"90th_percentile":24087.67},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":34328.14,"10th_percentile":34328.14,"90th_percentile":34328.14,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32565.92,"10th_percentile":32565.92,"90th_percentile":32565.92,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21875.98,"10th_percentile":21875.98,"90th_percentile":21875.98,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":12314.88,"10th_percentile":679.08,"90th_percentile":12954.88,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":729.78,"10th_percentile":679.08,"90th_percentile":13342.7,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":946.62,"10th_percentile":679.08,"90th_percentile":13989.63,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":946.62,"10th_percentile":679.08,"90th_percentile":13991.63,"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."}]}]},{"description":"Aicd Generator Procedures","code_information":[{"code":"245","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36809.55,"maximum":102859.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":76563.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37545.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":57846.67},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":82821.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":87506.83},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":66095.49},{"payer_name":"Blue Cross","plan_name":"Health Options - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":61359.65,"10th_percentile":61359.65,"90th_percentile":61359.65,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":17913.77,"maximum":49204.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37260.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18272.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":27671.92},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40305.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16899.97,"10th_percentile":16899.97,"90th_percentile":16899.97,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36227.32,"10th_percentile":36227.32,"90th_percentile":36227.32,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":12451.23,"maximum":33693.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25898.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12700.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18948.77},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28015.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":28664.51},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21650.82},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":21650.82},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":28664.51},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12451.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":24624.88},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":33693.5},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12700.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12575.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12575.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":27902.17},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":12451.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29142.75},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20991.75},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":29142.75},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12575.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13073.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12949.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12575.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":11626.03,"10th_percentile":587.98,"90th_percentile":11762.99,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":53097.98,"10th_percentile":53097.98,"90th_percentile":53097.98},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":587.98,"10th_percentile":587.98,"90th_percentile":11587.6,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":25644.34,"10th_percentile":25644.34,"90th_percentile":25644.34},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":9987.16,"10th_percentile":9987.16,"90th_percentile":9987.16,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":28281.48,"maximum":78643.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":58825.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28847.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":44228.16},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":63633.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":61473.22,"10th_percentile":61473.22,"90th_percentile":61473.22,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":50908.25,"10th_percentile":50908.25,"90th_percentile":50908.25,"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":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":23594.76,"10th_percentile":23594.76,"90th_percentile":23594.76,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":29566.02,"10th_percentile":29566.02,"90th_percentile":29566.02,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":62388.68,"10th_percentile":62388.68,"90th_percentile":62388.68,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":46553.96,"10th_percentile":46553.96,"90th_percentile":46553.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"13","median_amount":1387.18,"10th_percentile":1290.81,"90th_percentile":25024.81,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":25069.69,"10th_percentile":25069.69,"90th_percentile":25069.69,"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":"Other Vascular Procedures With Cc","code_information":[{"code":"253","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21193.68,"maximum":58517.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44082.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21617.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":32909.61},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":47685.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":49783.61},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37602.46},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":37602.46},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":49783.61},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21193.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":42767.7},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":58517.8},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21617.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21405.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21405.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":48459.59},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":21193.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":50614.2},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36457.8},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":50614.2},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21405.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22253.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22041.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21405.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":18827.09,"10th_percentile":960.65,"90th_percentile":20974.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":960.65,"10th_percentile":960.65,"90th_percentile":18455.8,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32793.01,"10th_percentile":32793.01,"90th_percentile":32793.01,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1359.37,"10th_percentile":960.65,"90th_percentile":19772.79,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":46431.41,"10th_percentile":46431.41,"90th_percentile":46431.41,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":17047.93,"10th_percentile":960.65,"90th_percentile":18725.54,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":18732.54,"10th_percentile":18732.54,"90th_percentile":18732.54,"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."}]}]},{"description":"Other Vascular Procedures Without Cc/Mcc","code_information":[{"code":"254","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14731.52,"maximum":40168.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30641.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15026.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22590.17},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33145.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":34173.01},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25811.49},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":25811.49},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":34173.01},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14731.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":29357.07},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":40168.43},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15026.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14878.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14878.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22180.64,"10th_percentile":22180.64,"90th_percentile":22180.64,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24086.62,"10th_percentile":24086.62,"90th_percentile":24086.62,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23713.73,"10th_percentile":23713.73,"90th_percentile":23713.73,"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":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27425.34,"10th_percentile":27425.34,"90th_percentile":27425.34,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":707.42,"10th_percentile":707.42,"90th_percentile":12938.36,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":12970.12,"10th_percentile":12970.12,"90th_percentile":12970.12,"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":"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":22001.94,"maximum":60812.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45764.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22441.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":34200.33},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":49504.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":51736.13},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39077.23},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":39077.23},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":51736.13},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22001.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":44445.06},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":60812.88},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22441.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22221.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22221.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":50360.19},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":22001.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":52599.3},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37887.68},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":52599.3},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22221.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23102.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22882.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22221.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":14066.17,"maximum":38279.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29257.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14347.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":21527.67},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31648.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":32565.72},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24597.48},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":24597.48},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":32565.72},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14066.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":27976.3},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":38279.16},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14347.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14206.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14206.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":9257.07,"maximum":24623.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19254.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9442.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13848.0},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20828.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":20948.4},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15822.7},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":15822.7},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":20948.4},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9257.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":17996.18},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":24623.65},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9442.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9349.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9349.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20391.26},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":9257.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21297.9},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15341.04},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":21297.9},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9349.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9719.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9627.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9349.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":25532.74,"maximum":70838.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":53108.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26043.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":39838.69},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":57448.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":60265.48},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45519.6},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":45519.6},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":60265.48},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25532.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":51772.38},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":70838.64},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26043.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25788.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25788.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":58662.69},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":25532.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":61270.95},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44133.94},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":61270.95},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25788.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26809.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26554.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25788.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":20214.83,"10th_percentile":20214.83,"90th_percentile":20214.83,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":20957.49,"10th_percentile":20957.49,"90th_percentile":20957.49,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":16640.24,"maximum":45588.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34611.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16973.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":25638.21},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37440.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":38783.88},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29294.16},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":29294.16},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":38783.88},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16640.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":33318.14},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":45588.24},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16973.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16806.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16806.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":37752.4},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":16640.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":39430.95},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28402.42},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":39430.95},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16806.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17472.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17305.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16806.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":26411.67,"maximum":73334.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":54936.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26939.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":41242.25},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":59426.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":62388.7},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":47123.31},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":47123.31},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":62388.7},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26411.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":53596.39},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":73334.38},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26939.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26675.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26675.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":60729.45},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":26411.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":63429.6},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45688.83},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":63429.6},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26675.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27732.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27468.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26675.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":24084.77,"10th_percentile":1703.56,"90th_percentile":24184.77,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":81989.95,"10th_percentile":81989.95,"90th_percentile":81989.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":24385.44,"10th_percentile":24385.44,"90th_percentile":24385.44,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":14872.28,"10th_percentile":1281.7,"90th_percentile":30377.48,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":94222.56,"10th_percentile":94222.56,"90th_percentile":94222.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":24602.93,"10th_percentile":24602.93,"90th_percentile":24602.93,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":24644.93,"10th_percentile":24644.93,"90th_percentile":24644.93,"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":"Cardiac Pacemaker Revision Except Device Replacement With Cc","code_information":[{"code":"261","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15595.37,"maximum":42621.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32438.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15907.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":23969.65},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35089.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":36259.79},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27387.67},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":27387.67},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":36259.79},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15595.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":31149.77},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":42621.32},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15907.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15751.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15751.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":35295.45},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":15595.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":36864.75},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26553.96},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":36864.75},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15751.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16375.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16219.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15751.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":714.04,"10th_percentile":714.04,"90th_percentile":714.04,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":714.04,"10th_percentile":714.04,"90th_percentile":714.04,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_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":714.04,"10th_percentile":714.04,"90th_percentile":714.04,"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":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":990.09,"10th_percentile":714.04,"90th_percentile":13993.7,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":13526.27,"maximum":36746.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28134.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13796.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":20665.5},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30434.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":31261.48},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23612.36},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":23612.36},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":31261.48},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13526.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":26855.86},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":36746.1},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13796.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13661.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13661.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":30430.07},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":13526.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":31783.05},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22893.58},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":31783.05},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13661.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14202.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14067.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13661.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31492.93,"10th_percentile":31492.93,"90th_percentile":31492.93,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":613.76,"10th_percentile":613.76,"90th_percentile":613.76,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27604.23,"10th_percentile":27604.23,"90th_percentile":27604.23,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":24860.25,"maximum":68929.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":51709.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25357.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":38764.77},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":55935.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":58640.93},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44292.55},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":44292.55},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":58640.93},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24860.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":50376.78},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":68929.08},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25357.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25108.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25108.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":57081.35},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":24860.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":59619.3},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42944.24},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":59619.3},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25108.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26103.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25854.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25108.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":27108.78,"maximum":75313.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":56386.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27650.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":42355.47},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":60994.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":64072.71},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48395.27},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":48395.27},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":64072.71},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27108.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":55043.07},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":75313.83},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27650.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27379.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27379.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":62368.67},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":27108.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":65141.7},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":46922.07},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":65141.7},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27379.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28464.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28193.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27379.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":53811.04,"10th_percentile":53811.04,"90th_percentile":53811.04,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":76458.95,"10th_percentile":76458.95,"90th_percentile":76458.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":27356.13,"10th_percentile":27356.13,"90th_percentile":27356.13,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":9171.44,"10th_percentile":9171.44,"90th_percentile":9171.44,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":45984.5,"10th_percentile":45984.5,"90th_percentile":45984.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":24429.5,"10th_percentile":24429.5,"90th_percentile":24440.97,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":29312.85,"maximum":81572.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":60970.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29899.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":45875.16},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":65953.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":25668.21,"10th_percentile":25668.21,"90th_percentile":25947.49,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":26272.55,"10th_percentile":1442.5,"90th_percentile":26328.95,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":49243.19,"maximum":138164.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":102425.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50228.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":77701.98},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":110797.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":43029.76,"10th_percentile":2254.24,"90th_percentile":45797.64,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":93917.77,"10th_percentile":93917.77,"90th_percentile":93917.77,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":9428.5,"10th_percentile":9428.5,"90th_percentile":9428.5,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"18","median_amount":3209.57,"10th_percentile":2254.24,"90th_percentile":43279.55,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":42826.92,"10th_percentile":42826.92,"90th_percentile":108954.68,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"36","median_amount":2422.55,"10th_percentile":2254.24,"90th_percentile":44399.01,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"19","median_amount":9583.5,"10th_percentile":2254.24,"90th_percentile":44200.41,"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."}]}]},{"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":38384.8,"maximum":107332.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":79840.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39152.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":60362.18},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":86365.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":69479.12,"10th_percentile":69479.12,"90th_percentile":69479.12,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"14","median_amount":2493.33,"10th_percentile":1770.31,"90th_percentile":33763.4,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":73755.58,"10th_percentile":73755.58,"90th_percentile":73755.58,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":86815.78,"10th_percentile":86815.78,"90th_percentile":87742.95},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"1 through 10","median_amount":74007.39,"10th_percentile":74007.39,"90th_percentile":74007.39},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":34177.51,"10th_percentile":1770.31,"90th_percentile":34177.51,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"26","median_amount":2493.33,"10th_percentile":1902.47,"90th_percentile":34101.06,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":13779.07,"10th_percentile":13779.07,"90th_percentile":13779.07,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":85564.38,"10th_percentile":85564.38,"90th_percentile":85564.38,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"38","median_amount":33176.03,"10th_percentile":1770.31,"90th_percentile":35020.16,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"13","median_amount":2493.33,"10th_percentile":1902.47,"90th_percentile":35923.54,"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."}]}]},{"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":55194.02,"maximum":155062.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":114803.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56297.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":87204.89},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":124186.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":17641.77,"10th_percentile":17641.77,"90th_percentile":17641.77,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":47780.49,"10th_percentile":47780.49,"90th_percentile":47780.49,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":34116.4,"maximum":95212.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":70962.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34798.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":53545.95},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":76761.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":81000.98},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":61181.5},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":61181.5},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":81000.98},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34116.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":69585.67},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":95212.04},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34798.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34457.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34457.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":78846.72},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":34116.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":82352.4},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":59319.07},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":82352.4},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34457.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35822.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35481.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34457.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":62969.23,"10th_percentile":62969.23,"90th_percentile":62969.23,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":30573.14,"10th_percentile":1565.61,"90th_percentile":32247.78,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":52518.25,"10th_percentile":52518.25,"90th_percentile":52518.25,"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":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":29972.68,"10th_percentile":29972.68,"90th_percentile":29972.68,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":30149.38,"10th_percentile":1565.61,"90th_percentile":31817.08,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":10587.02,"10th_percentile":10587.02,"90th_percentile":10587.02,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":31930.19,"10th_percentile":2211.78,"90th_percentile":31975.85,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"1 through 10","median_amount":31034.75,"10th_percentile":31034.75,"90th_percentile":31034.75,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":30275.86,"10th_percentile":1682.49,"90th_percentile":30285.34,"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."}]}]},{"description":"Other Major Cardiovascular Procedures With Mcc","code_information":[{"code":"270","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42477.73,"maximum":118954.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":88353.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43327.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":66898.21},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":95574.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":93620.79,"10th_percentile":93620.79,"90th_percentile":93620.79,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":69600.85,"10th_percentile":69600.85,"90th_percentile":69600.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":70753.27,"10th_percentile":70753.27,"90th_percentile":70753.27,"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":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":36864.38,"10th_percentile":36864.38,"90th_percentile":36864.38,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":80470.04,"10th_percentile":80470.04,"90th_percentile":80470.04,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"12","median_amount":31618.59,"10th_percentile":1931.47,"90th_percentile":39593.67,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":18084.43,"10th_percentile":18084.43,"90th_percentile":23517.7,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":45244.07,"10th_percentile":45244.07,"90th_percentile":45244.07,"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."}]}]},{"description":"Other Major Cardiovascular Procedures With Cc","code_information":[{"code":"271","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28821.38,"maximum":80176.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":59948.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29397.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":45090.33},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":64848.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"1 through 10","median_amount":49027.03,"10th_percentile":49027.03,"90th_percentile":49027.03},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":68521.68,"10th_percentile":66505.25,"90th_percentile":133539.21,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":49451.97,"10th_percentile":49451.97,"90th_percentile":49451.97,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":167983.39,"10th_percentile":167983.39,"90th_percentile":167983.39,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":24989.09,"10th_percentile":24989.09,"90th_percentile":26818.02,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":47847.37,"10th_percentile":47847.37,"90th_percentile":47847.37},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_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":1392.84,"10th_percentile":1392.84,"90th_percentile":1392.84,"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":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":24893.92,"10th_percentile":24893.92,"90th_percentile":24893.92,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"15","median_amount":1862.51,"10th_percentile":1296.08,"90th_percentile":30926.28,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":62643.3,"10th_percentile":62643.3,"90th_percentile":62643.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":48380.04,"10th_percentile":48380.04,"90th_percentile":48380.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"11","median_amount":1392.84,"10th_percentile":1296.08,"90th_percentile":24069.37,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"1 through 10","median_amount":1296.08,"10th_percentile":1296.08,"90th_percentile":1296.08,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":6749.77,"10th_percentile":1392.84,"90th_percentile":27023.43,"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."}]}]},{"description":"Other Major Cardiovascular Procedures Without Cc/Mcc","code_information":[{"code":"272","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20855.44,"maximum":57557.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43379.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21272.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":32369.49},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":46924.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":48966.54},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36985.31},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":36985.31},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":48966.54},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20855.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":42065.78},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":57557.39},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21272.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21063.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21063.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":47664.25},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":20855.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":49783.5},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35859.44},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":49783.5},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21063.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21898.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21689.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21063.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":44008.02,"10th_percentile":44008.02,"90th_percentile":44008.02,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1011.84,"10th_percentile":1011.84,"90th_percentile":18322.57,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":2100.0,"10th_percentile":941.54,"90th_percentile":18365.81,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":19549.05,"10th_percentile":19549.05,"90th_percentile":19549.05,"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":"Percutaneous And Other Intracardiac Procedures With Mcc","code_information":[{"code":"273","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33340.68,"maximum":93009.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":69348.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34007.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":52307.21},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":75016.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":79127.09},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":59766.12},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":59766.12},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":79127.09},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33340.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":67975.86},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":93009.4},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34007.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33674.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33674.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":77022.67},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":33340.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":80447.25},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":57946.77},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":80447.25},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33674.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35007.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34674.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33674.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":66166.86,"10th_percentile":66166.86,"90th_percentile":66166.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":28257.83,"10th_percentile":28257.83,"90th_percentile":28257.83,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":10349.04,"10th_percentile":10349.04,"90th_percentile":10349.04,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":67435.75,"10th_percentile":67435.75,"90th_percentile":67435.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":20106.1,"10th_percentile":20106.1,"90th_percentile":20106.1,"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":"Percutaneous And Other Intracardiac Procedures Without Mcc","code_information":[{"code":"274","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26720.53,"maximum":74211.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":55578.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27254.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":41735.46},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":60121.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21972.19,"10th_percentile":21972.19,"90th_percentile":39889.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":43019.86,"10th_percentile":43019.86,"90th_percentile":48039.07,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"29","median_amount":1723.93,"10th_percentile":1174.38,"90th_percentile":22679.82,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":54638.93,"10th_percentile":48927.92,"90th_percentile":56923.92,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":22805.06,"10th_percentile":1174.38,"90th_percentile":28990.47,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"66","median_amount":1723.93,"10th_percentile":1174.38,"90th_percentile":25263.24,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":55307.79,"10th_percentile":55307.79,"90th_percentile":55307.79},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":8843.97,"10th_percentile":8843.97,"90th_percentile":8843.97,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":56761.63,"10th_percentile":56761.63,"90th_percentile":60859.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":213139.55,"10th_percentile":213139.55,"90th_percentile":213139.55,"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":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"62","median_amount":1723.93,"10th_percentile":1174.38,"90th_percentile":24863.56,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"37","median_amount":1723.93,"10th_percentile":1174.38,"90th_percentile":25016.0,"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":"Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc","code_information":[{"code":"275","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":57198.8,"maximum":160754.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":118973.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58342.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":90406.34},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":128697.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":50605.57,"10th_percentile":50605.57,"90th_percentile":50605.57,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":128895.01,"10th_percentile":128895.01,"90th_percentile":128895.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":85383.61,"10th_percentile":85383.61,"90th_percentile":85383.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":44578.89,"10th_percentile":3145.78,"90th_percentile":44605.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":97109.61,"10th_percentile":97109.61,"90th_percentile":97109.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":33715.94,"10th_percentile":2330.86,"90th_percentile":45333.12,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":44204.56,"10th_percentile":44204.56,"90th_percentile":44204.56,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"1 through 10","median_amount":45516.5,"10th_percentile":45516.5,"90th_percentile":45516.5,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":37254.97,"maximum":104124.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":77490.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38000.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":58557.96},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":83823.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":33276.05,"10th_percentile":1750.44,"90th_percentile":33446.5,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":89238.66,"10th_percentile":89238.66,"90th_percentile":89238.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":33308.34,"10th_percentile":33308.34,"90th_percentile":33308.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":33479.08,"10th_percentile":1750.44,"90th_percentile":34841.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"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":44779.46,"maximum":125489.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":93141.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45675.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":70573.85},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":100753.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"46","median_amount":663.74,"10th_percentile":500.0,"90th_percentile":12316.33,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12301.33,"10th_percentile":12301.33,"90th_percentile":12301.33,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"1 through 10","median_amount":46357.56,"10th_percentile":46357.56,"90th_percentile":46357.56},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":29662.92,"10th_percentile":29488.48,"90th_percentile":29816.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"25","median_amount":840.1,"10th_percentile":617.64,"90th_percentile":12114.59,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21306.55,"10th_percentile":21306.55,"90th_percentile":23632.16,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":23819.58,"10th_percentile":23819.58,"90th_percentile":23819.58},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"33","median_amount":840.1,"10th_percentile":617.64,"90th_percentile":12169.78,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_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":3816.46,"10th_percentile":3816.46,"90th_percentile":3816.46,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":2611.78,"10th_percentile":2611.78,"90th_percentile":2611.78,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":52133.77,"10th_percentile":52133.77,"90th_percentile":52133.77,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22275.44,"10th_percentile":22275.44,"90th_percentile":22275.44,"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":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27880.5,"10th_percentile":27880.5,"90th_percentile":27880.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"64","median_amount":840.1,"10th_percentile":617.64,"90th_percentile":12390.67,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"1 through 10","median_amount":10217.85,"10th_percentile":617.64,"90th_percentile":10484.53,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"16","median_amount":840.1,"10th_percentile":614.7,"90th_percentile":12229.72,"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."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Cc","code_information":[{"code":"281","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7882.7,"maximum":20721.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16396.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8040.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11653.27},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17736.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":17628.34},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13315.0},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":13315.0},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":17628.34},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7882.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":15144.01},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":20721.11},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8040.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7961.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7961.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17159.51},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":7882.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17922.45},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12909.68},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":17922.45},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7961.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8276.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8198.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7961.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":14530.51,"10th_percentile":14530.51,"90th_percentile":14530.51,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"16","median_amount":372.75,"10th_percentile":346.86,"90th_percentile":7086.83,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":20232.42,"10th_percentile":20232.42,"90th_percentile":29172.91},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":16850.14,"10th_percentile":16850.14,"90th_percentile":18043.27,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9706.09,"10th_percentile":6706.09,"90th_percentile":9802.54,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":481.36,"10th_percentile":481.36,"90th_percentile":6718.48,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13006.02,"10th_percentile":12951.06,"90th_percentile":14656.14,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":28104.82,"10th_percentile":28104.82,"90th_percentile":28104.82},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"1 through 10","median_amount":14081.89,"10th_percentile":14081.89,"90th_percentile":14081.89},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":7033.89,"10th_percentile":7033.89,"90th_percentile":7033.89,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"17","median_amount":481.36,"10th_percentile":346.86,"90th_percentile":7098.83,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":5082.7,"10th_percentile":5082.7,"90th_percentile":5082.7,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16764.78,"10th_percentile":16764.78,"90th_percentile":16764.78,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12509.75,"10th_percentile":12509.75,"90th_percentile":12509.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"25","median_amount":372.75,"10th_percentile":346.86,"90th_percentile":7052.36,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"13","median_amount":372.75,"10th_percentile":346.86,"90th_percentile":7035.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc","code_information":[{"code":"282","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6326.52,"maximum":16302.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13159.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6453.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9168.18},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14234.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":13869.06},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10475.55},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":10475.55},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":13869.06},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6326.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":11914.52},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":16302.29},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6453.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6389.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6389.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13500.2},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":6326.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14100.45},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10156.66},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":14100.45},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6389.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6642.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6579.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6389.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":11777.52,"10th_percentile":11777.52,"90th_percentile":11777.52,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"12","median_amount":5612.2,"10th_percentile":272.84,"90th_percentile":5663.65,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11772.61,"10th_percentile":11772.61,"90th_percentile":11772.61,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"1 through 10","median_amount":9588.7,"10th_percentile":9588.7,"90th_percentile":9588.7},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":6430.39,"10th_percentile":6430.39,"90th_percentile":6430.39},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":13506.84,"10th_percentile":13506.84,"90th_percentile":13506.84,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10655.44,"10th_percentile":10655.44,"90th_percentile":10655.44,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7958.8,"10th_percentile":7958.8,"90th_percentile":7958.8,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":378.7,"10th_percentile":272.84,"90th_percentile":5810.97,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11702.74,"10th_percentile":11702.74,"90th_percentile":11702.74,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_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":272.84,"10th_percentile":272.84,"90th_percentile":272.84,"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":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1205.51,"10th_percentile":272.84,"90th_percentile":5946.48,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":3117.76,"10th_percentile":3117.76,"90th_percentile":3117.76,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":293.22,"10th_percentile":293.22,"90th_percentile":4021.51,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":272.84,"10th_percentile":272.84,"90th_percentile":272.84,"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."}]}]},{"description":"Acute Myocardial Infarction, Expired With Mcc","code_information":[{"code":"283","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16312.32,"maximum":44657.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33929.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16638.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":25114.56},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36702.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28907.8,"10th_percentile":28907.8,"90th_percentile":28907.8,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":14395.07,"10th_percentile":14395.07,"90th_percentile":14395.07,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":735.78,"10th_percentile":735.78,"90th_percentile":735.78,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":14449.09,"10th_percentile":14449.09,"90th_percentile":14449.09,"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."}]}]},{"description":"Acute Myocardial Infarction, Expired With Cc","code_information":[{"code":"284","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6081.18,"maximum":15605.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12648.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6202.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8776.4},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13682.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":13276.4},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10027.9},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":10027.9},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":13276.4},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6081.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":11405.38},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":15605.65},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6202.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6141.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6141.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12923.3},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":6081.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13497.9},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9722.64},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":13497.9},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6141.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6385.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6324.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6141.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":5340.4,"maximum":13502.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11108.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5447.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":7593.45},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12015.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":11486.9},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8676.26},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":8676.26},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":11486.9},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5340.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":9868.08},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":13502.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5447.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5393.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5393.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11181.4},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":5340.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11678.55},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8412.15},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":11678.55},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5393.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5607.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5554.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5393.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":5366.42,"10th_percentile":5366.42,"90th_percentile":5366.42,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":18154.34,"maximum":49887.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37761.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18517.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":28056.09},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40847.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":42441.5},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32056.83},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":32056.83},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":42441.5},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18154.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":36460.31},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":49887.58},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18517.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18335.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18335.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":41312.75},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":18154.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":43149.6},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31080.99},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":43149.6},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18335.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19062.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18880.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18335.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":33886.55,"10th_percentile":33886.55,"90th_percentile":33886.55,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":16447.92,"10th_percentile":832.83,"90th_percentile":17472.26,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28062.43,"10th_percentile":28062.43,"90th_percentile":37683.97,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":27583.47,"10th_percentile":27583.47,"90th_percentile":27583.47},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":41767.45,"10th_percentile":41767.45,"90th_percentile":41767.45,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":15958.48,"10th_percentile":1158.89,"90th_percentile":16247.91,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33127.19,"10th_percentile":33127.19,"90th_percentile":34097.9,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":52279.71,"10th_percentile":52279.71,"90th_percentile":52279.71},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"26","median_amount":8301.21,"10th_percentile":832.83,"90th_percentile":16875.53,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":57104.48,"10th_percentile":57104.48,"90th_percentile":57104.48},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":43159.35,"10th_percentile":43159.35,"90th_percentile":43159.35,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"16","median_amount":14854.53,"10th_percentile":832.83,"90th_percentile":16286.65,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"1 through 10","median_amount":1158.89,"10th_percentile":1158.89,"90th_percentile":15797.78,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"23","median_amount":1812.14,"10th_percentile":832.83,"90th_percentile":17024.9,"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":"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc","code_information":[{"code":"287","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9081.6,"maximum":24125.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18889.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9263.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13567.8},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20433.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":20524.52},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15502.54},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":15502.54},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":20524.52},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9081.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":17632.04},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":24125.4},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9263.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9172.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9172.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19978.66},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":9081.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20866.95},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15030.62},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":20866.95},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9172.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9535.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9444.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9172.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":17273.42,"10th_percentile":17273.42,"90th_percentile":17273.42,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"23","median_amount":440.65,"10th_percentile":410.04,"90th_percentile":8616.98,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13867.8,"10th_percentile":13867.8,"90th_percentile":13867.8,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"1 through 10","median_amount":8501.97,"10th_percentile":8501.97,"90th_percentile":8501.97},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":11806.06,"10th_percentile":11806.06,"90th_percentile":22265.67},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":19743.35,"10th_percentile":19735.38,"90th_percentile":19852.11,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16479.31,"10th_percentile":16098.12,"90th_percentile":20277.22,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12020.42,"10th_percentile":10009.74,"90th_percentile":12201.0,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":7986.43,"10th_percentile":410.04,"90th_percentile":8175.14,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16283.23,"10th_percentile":14083.23,"90th_percentile":16833.23,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":47188.07,"10th_percentile":47188.07,"90th_percentile":47188.07},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"1 through 10","median_amount":3989.33,"10th_percentile":3989.33,"90th_percentile":3989.33,"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":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":8227.23,"10th_percentile":8227.23,"90th_percentile":8227.23,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"25","median_amount":410.04,"10th_percentile":410.04,"90th_percentile":8600.02,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":4129.56,"10th_percentile":4129.56,"90th_percentile":4129.56,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19818.37,"10th_percentile":8067.62,"90th_percentile":20519.37,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14788.32,"10th_percentile":14788.32,"90th_percentile":14788.32,"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":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"27","median_amount":410.04,"10th_percentile":410.04,"90th_percentile":8219.83,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":440.65,"10th_percentile":410.04,"90th_percentile":8227.73,"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."}]}]},{"description":"Acute And Subacute Endocarditis With Mcc","code_information":[{"code":"288","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22071.81,"maximum":61011.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45909.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22513.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":34311.91},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":49661.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":51904.92},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39204.72},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":39204.72},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":51904.92},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22071.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":44590.06},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":61011.28},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22513.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22292.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22292.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":50524.48},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":22071.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":52770.9},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38011.29},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":52770.9},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22292.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23175.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22954.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22292.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":14137.63,"maximum":38482.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29406.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14420.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":21641.79},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31809.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":32738.34},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24727.86},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":24727.86},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":32738.34},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14137.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":28124.59},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":38482.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14420.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14279.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14279.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":31867.65},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":14137.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":33284.55},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23975.12},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":33284.55},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14279.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14844.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14703.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14279.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"116","median_amount":672.35,"10th_percentile":490.98,"90th_percentile":9899.83,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19087.56,"10th_percentile":19087.56,"90th_percentile":20518.66,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":62384.08,"10th_percentile":62384.08,"90th_percentile":62384.08},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"12","median_amount":23757.98,"10th_percentile":23409.97,"90th_percentile":24504.59,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22492.71,"10th_percentile":22492.71,"90th_percentile":22492.71,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16220.36,"10th_percentile":14076.61,"90th_percentile":17985.36,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23798.25,"10th_percentile":23798.25,"90th_percentile":23798.25,"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] [MSDRG Base Rate: 100% of Medicare]","count":"54","median_amount":672.35,"10th_percentile":490.98,"90th_percentile":9706.9,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20455.35,"10th_percentile":20455.35,"90th_percentile":20455.35,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":22100.46,"10th_percentile":22100.46,"90th_percentile":42704.92},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"1 through 10","median_amount":4198.11,"10th_percentile":4198.11,"90th_percentile":4198.11,"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":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":9768.32,"10th_percentile":490.98,"90th_percentile":10108.38,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"162","median_amount":672.35,"10th_percentile":490.98,"90th_percentile":9872.79,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_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":2573.42,"10th_percentile":2573.42,"90th_percentile":3816.46,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":3816.46,"10th_percentile":3816.46,"90th_percentile":3816.46,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":3816.46,"10th_percentile":2573.42,"90th_percentile":3816.46,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23730.4,"10th_percentile":23466.0,"90th_percentile":25443.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17707.44,"10th_percentile":17707.44,"90th_percentile":18032.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"214","median_amount":672.35,"10th_percentile":377.66,"90th_percentile":9779.73,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"1 through 10","median_amount":10357.97,"10th_percentile":10357.97,"90th_percentile":10357.97,"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] [MSDRG Base Rate: 104% of Medicare]","count":"1 through 10","median_amount":8025.54,"10th_percentile":490.98,"90th_percentile":9568.96,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"62","median_amount":672.35,"10th_percentile":490.98,"90th_percentile":9792.12,"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":"Heart Failure And Shock With Cc","code_information":[{"code":"292","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7326.13,"maximum":19140.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15238.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7472.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10764.47},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16483.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":16283.82},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12299.46},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":12299.46},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":16283.82},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7326.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":13988.97},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":19140.71},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7472.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7399.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7399.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15850.75},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":7326.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16555.5},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11925.05},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":16555.5},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7399.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7692.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7619.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7399.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":6666.45,"10th_percentile":6666.45,"90th_percentile":6666.45,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":444.64,"10th_percentile":444.64,"90th_percentile":5780.65,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13501.03,"10th_percentile":13501.03,"90th_percentile":13501.03,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":6517.53,"10th_percentile":348.25,"90th_percentile":6644.45,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":2573.42,"10th_percentile":2573.42,"90th_percentile":2573.42,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":324.06,"10th_percentile":324.06,"90th_percentile":6910.59,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":444.64,"10th_percentile":348.25,"90th_percentile":6900.47,"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."}]}]},{"description":"Heart Failure And Shock Without Cc/Mcc","code_information":[{"code":"293","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5079.18,"maximum":12760.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10564.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5180.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":7176.31},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11428.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":10855.88},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8199.64},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":8199.64},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":10855.88},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5079.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":9325.98},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":12760.47},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5180.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5129.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5129.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10567.16},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":5079.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11037.0},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7950.04},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":11037.0},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5129.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5333.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5282.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5129.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":206.47,"10th_percentile":206.47,"90th_percentile":206.47,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":221.88,"10th_percentile":221.88,"90th_percentile":221.88,"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."}]}]},{"description":"Cardiac Arrest, Unexplained With Mcc","code_information":[{"code":"296","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12986.37,"maximum":35213.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27011.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13246.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19803.33},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29219.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":29957.24},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22627.25},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":22627.25},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":29957.24},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12986.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":25735.43},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":35213.04},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13246.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13116.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13116.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29160.52},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":12986.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":30457.05},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21938.45},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":30457.05},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13116.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13635.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13505.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13116.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":616.51,"10th_percentile":616.51,"90th_percentile":616.51,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":5619.08,"maximum":14293.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11687.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5731.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8038.49},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12642.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":12160.12},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9184.76},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":9184.76},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":12160.12},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5619.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":10446.42},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":14293.53},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5731.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5675.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5675.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11836.72},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":5619.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12363.0},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8905.16},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":12363.0},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5675.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5900.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5843.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5675.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":4198.67,"maximum":10260.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8733.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4282.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":5770.21},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9447.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":8728.82},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6593.03},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":6593.03},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":8728.82},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4198.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":7498.68},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":10260.23},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4282.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4240.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4240.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8496.67},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":4198.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8874.45},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6392.33},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":8874.45},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4240.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4408.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4366.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4240.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":3922.26,"10th_percentile":3922.26,"90th_percentile":3922.26,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":13548.5,"maximum":36809.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28180.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13819.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":20701.0},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30484.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":31315.19},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23652.92},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":23652.92},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":31315.19},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13548.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":26902.0},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":36809.22},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13819.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13683.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13683.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":30482.35},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":13548.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":31837.65},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22932.9},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":31837.65},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13683.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14225.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14090.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13683.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"11","median_amount":654.12,"10th_percentile":456.51,"90th_percentile":12825.88,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"1 through 10","median_amount":14360.48,"10th_percentile":14360.48,"90th_percentile":14360.48},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":29241.95,"10th_percentile":29241.95,"90th_percentile":31709.05,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22297.0,"10th_percentile":22297.0,"90th_percentile":22297.0,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":10935.85,"10th_percentile":608.68,"90th_percentile":11783.15,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22630.76,"10th_percentile":22630.76,"90th_percentile":29503.41,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":30182.57,"10th_percentile":30182.57,"90th_percentile":30182.57},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":855.08,"10th_percentile":608.68,"90th_percentile":13294.62,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29419.29,"10th_percentile":29419.29,"90th_percentile":29419.29,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":10264.74,"10th_percentile":608.68,"90th_percentile":12260.27,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":11903.75,"10th_percentile":654.12,"90th_percentile":12013.86,"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."}]}]},{"description":"Peripheral Vascular Disorders With Cc","code_information":[{"code":"300","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9060.96,"maximum":24066.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18846.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9242.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13534.83},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20387.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":20474.65},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15464.87},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":15464.87},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":20474.65},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9060.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":17589.2},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":24066.79},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9242.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9151.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9151.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19930.12},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":9060.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20816.25},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14994.11},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":20816.25},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9151.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9514.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9423.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9151.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":402.85,"10th_percentile":389.84,"90th_percentile":8494.19,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":19515.87,"10th_percentile":19515.87,"90th_percentile":19737.43,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20626.24,"10th_percentile":20626.24,"90th_percentile":20626.24,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14757.15,"10th_percentile":14757.15,"90th_percentile":15579.1,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":6728.04,"10th_percentile":559.07,"90th_percentile":8000.71,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9719.13,"10th_percentile":9719.13,"90th_percentile":9719.13,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"1 through 10","median_amount":3035.59,"10th_percentile":3035.59,"90th_percentile":3035.59,"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":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"15","median_amount":842.15,"10th_percentile":402.85,"90th_percentile":8177.7,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":4188.27,"10th_percentile":4188.27,"90th_percentile":4188.27,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1125.04,"10th_percentile":1125.04,"90th_percentile":1125.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"11","median_amount":432.92,"10th_percentile":402.85,"90th_percentile":9057.68,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":559.07,"10th_percentile":418.94,"90th_percentile":8523.86,"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."}]}]},{"description":"Peripheral Vascular Disorders Without Cc/Mcc","code_information":[{"code":"301","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6299.52,"maximum":16225.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13103.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6425.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9125.08},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14173.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":13803.85},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10426.29},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":10426.29},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":13803.85},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6299.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":11858.5},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":16225.64},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6425.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6362.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6362.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9833.51,"10th_percentile":9833.51,"90th_percentile":9833.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":5451.04,"10th_percentile":5451.04,"90th_percentile":5451.04,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":730.47,"10th_percentile":268.44,"90th_percentile":11313.31,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":288.48,"10th_percentile":268.44,"90th_percentile":5791.22,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1400.0,"10th_percentile":1400.0,"90th_percentile":1400.0,"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":"Atherosclerosis With Mcc","code_information":[{"code":"302","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10085.98,"maximum":26977.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20978.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10287.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15171.69},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22693.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":22950.79},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17335.14},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":17335.14},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":22950.79},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10085.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":19716.38},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":26977.35},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10287.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10186.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10186.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22340.4},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":10085.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23333.7},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16807.44},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":23333.7},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10186.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10590.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10489.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10186.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":437.74,"10th_percentile":437.74,"90th_percentile":437.74,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8526.32,"10th_percentile":8526.32,"90th_percentile":8526.32,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":8705.69,"10th_percentile":8705.69,"90th_percentile":8705.69,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":13275.5,"10th_percentile":13275.5,"90th_percentile":13275.5,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":5930.32,"maximum":15177.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12335.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6048.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8535.5},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13343.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":12678.08,"10th_percentile":12678.08,"90th_percentile":12678.08,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9100.19,"10th_percentile":9100.19,"90th_percentile":9100.19,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9268.36,"10th_percentile":9268.36,"90th_percentile":9268.36,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":5070.36,"10th_percentile":5070.36,"90th_percentile":5070.36,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"15","median_amount":3205.53,"10th_percentile":253.02,"90th_percentile":11272.32,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7383.35,"10th_percentile":7383.35,"90th_percentile":7383.35,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":277.61,"10th_percentile":271.9,"90th_percentile":352.56,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":5230.82,"10th_percentile":5230.82,"90th_percentile":5230.82,"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."}]}]},{"description":"Hypertension With Mcc","code_information":[{"code":"304","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10033.58,"maximum":26828.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20869.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10234.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15088.01},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22575.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":22824.2},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17239.53},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":17239.53},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":22824.2},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10033.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":19607.63},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":26828.55},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10234.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10133.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10133.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22217.18},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":10033.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23205.0},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16714.74},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":23205.0},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10133.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10535.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10434.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10133.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":21423.83,"10th_percentile":21423.83,"90th_percentile":21423.83,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19677.18,"10th_percentile":19677.18,"90th_percentile":19677.18,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16193.44,"10th_percentile":16193.44,"90th_percentile":16193.44,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":5266.12,"10th_percentile":5266.12,"90th_percentile":8629.04,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":2438.56,"10th_percentile":2438.56,"90th_percentile":8775.23,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":7431.01,"10th_percentile":442.06,"90th_percentile":9173.57,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":475.06,"10th_percentile":442.06,"90th_percentile":8854.37,"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."}]}]},{"description":"Hypertension Without Mcc","code_information":[{"code":"305","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6580.59,"maximum":17023.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13687.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6712.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9573.91},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14806.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":14482.82},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10939.13},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":10939.13},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":14482.82},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6580.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":12441.78},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":17023.73},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6712.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6646.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6646.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14097.64},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":6580.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14724.45},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10606.13},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":14724.45},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6646.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6909.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6843.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6646.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":12043.97,"10th_percentile":12043.97,"90th_percentile":12043.97,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":282.48,"10th_percentile":282.48,"90th_percentile":8286.27,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9518.13,"10th_percentile":9518.13,"90th_percentile":9518.13,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":13944.2,"10th_percentile":13909.93,"90th_percentile":15419.18,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15594.26,"10th_percentile":15594.26,"90th_percentile":15594.26,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7349.41,"10th_percentile":4347.65,"90th_percentile":8547.65,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19471.36,"10th_percentile":19471.36,"90th_percentile":19471.36,"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":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":282.48,"10th_percentile":282.48,"90th_percentile":5752.08,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9254.98,"10th_percentile":9254.98,"90th_percentile":9908.59,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":28910.62,"10th_percentile":28910.62,"90th_percentile":28910.62},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"11","median_amount":395.46,"10th_percentile":282.48,"90th_percentile":5818.99,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":2103.96,"10th_percentile":2103.96,"90th_percentile":2103.96,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14638.65,"10th_percentile":14638.65,"90th_percentile":14638.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8185.83,"10th_percentile":8185.83,"90th_percentile":8185.83,"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":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"16","median_amount":621.57,"10th_percentile":282.48,"90th_percentile":5735.2,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":13096.73,"maximum":35526.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27241.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13358.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19979.57},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29467.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29420.03},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":13096.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":30728.1},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22133.69},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":30728.1},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13227.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13751.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13620.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13227.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":563.45,"10th_percentile":563.45,"90th_percentile":9257.84,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":9679.38,"10th_percentile":563.45,"90th_percentile":11151.72,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":7835.86,"maximum":20588.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16298.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7992.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11578.46},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17630.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":17515.18},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13229.53},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":13229.53},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":17515.18},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7835.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":15046.8},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":20588.09},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7992.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7914.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7914.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17049.35},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":7835.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17807.4},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12826.81},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":17807.4},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7914.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8227.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8149.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7914.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":348.59,"10th_percentile":348.59,"90th_percentile":7128.77,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"1 through 10","median_amount":12513.5,"10th_percentile":12513.5,"90th_percentile":12513.5},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"11","median_amount":478.26,"10th_percentile":348.59,"90th_percentile":3200.14,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":374.61,"10th_percentile":374.61,"90th_percentile":5403.16,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":7050.38,"10th_percentile":7050.38,"90th_percentile":7050.38,"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."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Mcc","code_information":[{"code":"308","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10144.74,"maximum":27144.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21101.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10347.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15265.52},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22825.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":23092.72},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17442.35},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":17442.35},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":23092.72},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10144.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":19838.31},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":27144.18},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10347.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10246.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10246.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22478.56},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":10144.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23478.0},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16911.38},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":23478.0},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10246.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10651.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10550.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10246.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":19034.66,"10th_percentile":19034.66,"90th_percentile":19034.66,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"20","median_amount":487.64,"10th_percentile":453.76,"90th_percentile":9621.86,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2449.06,"10th_percentile":2449.06,"90th_percentile":2449.06,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"1 through 10","median_amount":24835.27,"10th_percentile":24835.27,"90th_percentile":24835.27},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":25680.85,"10th_percentile":25680.85,"90th_percentile":25680.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21644.41,"10th_percentile":21644.41,"90th_percentile":21994.41,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16622.13,"10th_percentile":16622.13,"90th_percentile":16622.13,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":630.56,"10th_percentile":453.76,"90th_percentile":9001.0,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17301.96,"10th_percentile":17301.96,"90th_percentile":17301.96,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"1 through 10","median_amount":89429.64,"10th_percentile":89429.64,"90th_percentile":89429.64},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_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":630.56,"10th_percentile":630.56,"90th_percentile":630.56,"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":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"27","median_amount":630.56,"10th_percentile":378.43,"90th_percentile":9638.26,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23833.05,"10th_percentile":23833.05,"90th_percentile":23833.05,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21931.7,"10th_percentile":21931.7,"90th_percentile":21931.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"26","median_amount":1375.0,"10th_percentile":453.76,"90th_percentile":9372.06,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"15","median_amount":453.76,"10th_percentile":453.76,"90th_percentile":9070.85,"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":"Cardiac Arrhythmia And Conduction Disorders With Cc","code_information":[{"code":"309","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6426.56,"maximum":16586.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13367.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6555.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9327.94},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14459.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":14110.73},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10658.09},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":10658.09},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":14110.73},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6426.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":12122.13},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":16586.36},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6555.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6490.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6490.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13735.45},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":6426.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14346.15},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10333.64},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":14346.15},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6490.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6747.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6683.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6490.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":1833.84,"10th_percentile":1833.84,"90th_percentile":1833.84,"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":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"37","median_amount":298.96,"10th_percentile":278.19,"90th_percentile":5772.2,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9373.58,"10th_percentile":9373.58,"90th_percentile":9373.58,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"1 through 10","median_amount":8057.69,"10th_percentile":8057.69,"90th_percentile":8057.69},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":6578.65,"10th_percentile":6578.65,"90th_percentile":7749.38},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":14149.06,"10th_percentile":13822.76,"90th_percentile":14955.1,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10787.27,"10th_percentile":10072.82,"90th_percentile":10990.01,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10190.51,"10th_percentile":9337.81,"90th_percentile":10190.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"19","median_amount":4488.83,"10th_percentile":278.19,"90th_percentile":5646.79,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10990.01,"10th_percentile":10990.01,"90th_percentile":11590.01,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_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":278.19,"10th_percentile":278.19,"90th_percentile":278.19,"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":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":5707.12,"10th_percentile":278.19,"90th_percentile":5707.12,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"23","median_amount":385.3,"10th_percentile":278.19,"90th_percentile":5737.38,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":24241.71,"10th_percentile":24241.71,"90th_percentile":24241.71},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13445.65,"10th_percentile":13445.65,"90th_percentile":13445.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":42094.36,"10th_percentile":42094.36,"90th_percentile":42094.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"45","median_amount":385.3,"10th_percentile":278.19,"90th_percentile":5711.12,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"31","median_amount":385.3,"10th_percentile":278.19,"90th_percentile":5717.0,"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":"Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc","code_information":[{"code":"310","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5079.98,"maximum":12762.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10566.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5181.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":7177.58},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11429.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":10857.8},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8201.09},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":8201.09},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":10857.8},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5079.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":9327.63},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":12762.72},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5181.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5130.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5130.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10569.03},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":5079.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11038.95},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7951.44},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":11038.95},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5130.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5333.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5283.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5130.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":9277.96,"10th_percentile":9277.96,"90th_percentile":9277.96,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"13","median_amount":870.0,"10th_percentile":210.53,"90th_percentile":4480.15,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":5050.92,"10th_percentile":5050.92,"90th_percentile":5050.92},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":10628.39,"10th_percentile":10628.39,"90th_percentile":10628.39,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10204.72,"10th_percentile":4594.4,"90th_percentile":12857.26,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5957.15,"10th_percentile":5957.15,"90th_percentile":7712.15,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2780.36,"10th_percentile":2780.36,"90th_percentile":2780.36,"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":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":296.48,"10th_percentile":210.53,"90th_percentile":4387.4,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7955.33,"10th_percentile":4902.1,"90th_percentile":9704.72,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_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":296.48,"10th_percentile":296.48,"90th_percentile":296.48,"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":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"17","median_amount":242.36,"10th_percentile":210.53,"90th_percentile":4464.14,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10175.63,"10th_percentile":10175.63,"90th_percentile":11038.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35741.91,"10th_percentile":35741.91,"90th_percentile":35741.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"16","median_amount":296.48,"10th_percentile":210.53,"90th_percentile":4785.12,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"1 through 10","median_amount":4580.24,"10th_percentile":4580.24,"90th_percentile":4580.24,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":296.48,"10th_percentile":210.53,"90th_percentile":4795.21,"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."}]}]},{"description":"Angina Pectoris","code_information":[{"code":"311","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6158.19,"maximum":15824.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12809.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6281.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8899.39},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13855.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":13462.44},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10168.43},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":10168.43},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":13462.44},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6158.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":11565.21},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":15824.34},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6281.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6219.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6219.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13104.4},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":6158.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13687.05},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9858.89},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":13687.05},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6219.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6466.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6404.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6219.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":5423.56,"10th_percentile":5423.56,"90th_percentile":5423.56,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10189.04,"10th_percentile":10189.04,"90th_percentile":10189.04,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4462.51,"10th_percentile":4462.51,"90th_percentile":4462.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":7505.57,"maximum":19650.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15611.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7655.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11051.02},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16887.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"25","median_amount":327.86,"10th_percentile":327.86,"90th_percentile":6750.67,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":27830.42,"10th_percentile":27830.42,"90th_percentile":27830.42},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10927.5,"10th_percentile":10927.5,"90th_percentile":10927.5,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12010.0,"10th_percentile":12010.0,"90th_percentile":12010.0,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9828.71,"10th_percentile":9828.71,"90th_percentile":9828.71,"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":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"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":456.47,"10th_percentile":327.86,"90th_percentile":6507.5,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10847.54,"10th_percentile":10847.54,"90th_percentile":10847.54,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"30","median_amount":352.34,"10th_percentile":327.86,"90th_percentile":6641.57,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":3401.64,"10th_percentile":3401.64,"90th_percentile":3401.64,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15846.33,"10th_percentile":15846.33,"90th_percentile":15846.33,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"37","median_amount":352.34,"10th_percentile":277.61,"90th_percentile":6672.81,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"1 through 10","median_amount":7056.37,"10th_percentile":7056.37,"90th_percentile":7056.37,"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] [MSDRG Base Rate: 104% of Medicare]","count":"1 through 10","median_amount":327.86,"10th_percentile":327.86,"90th_percentile":6849.39,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"16","median_amount":456.47,"10th_percentile":327.86,"90th_percentile":6663.51,"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."}]}]},{"description":"Chest Pain","code_information":[{"code":"313","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6301.9,"maximum":16232.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13107.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6427.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9128.88},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14179.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":13809.6},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10430.64},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":10430.64},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":13809.6},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6301.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":11863.44},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":16232.4},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6427.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6364.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6364.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13442.33},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":6301.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14040.0},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10113.12},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":14040.0},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6364.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6617.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6553.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6364.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":268.44,"10th_percentile":268.44,"90th_percentile":3604.0,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":12417.68,"10th_percentile":12417.68,"90th_percentile":12417.68},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":13382.91,"10th_percentile":13382.91,"90th_percentile":13382.91,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9413.43,"10th_percentile":9413.43,"90th_percentile":9413.43,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9833.51,"10th_percentile":9833.51,"90th_percentile":9833.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":5140.85,"10th_percentile":268.44,"90th_percentile":5488.12,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":268.44,"10th_percentile":268.44,"90th_percentile":5503.0,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":2206.41,"10th_percentile":2206.41,"90th_percentile":2541.71,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"15","median_amount":288.48,"10th_percentile":268.44,"90th_percentile":5521.69,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":288.48,"10th_percentile":288.48,"90th_percentile":288.48,"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":"Other Circulatory System Diagnoses With Mcc","code_information":[{"code":"314","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17141.23,"maximum":47010.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35653.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17484.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":26438.25},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38567.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27304.23,"10th_percentile":27304.23,"90th_percentile":27304.23,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":38124.68,"10th_percentile":38124.68,"90th_percentile":38450.97,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35888.06,"10th_percentile":35888.06,"90th_percentile":35888.06,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29683.84,"10th_percentile":29683.84,"90th_percentile":30431.41,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":82463.06,"10th_percentile":82463.06,"90th_percentile":82463.06,"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":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":810.33,"10th_percentile":810.33,"90th_percentile":15764.42,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33731.92,"10th_percentile":33731.92,"90th_percentile":33760.42,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"21","median_amount":810.33,"10th_percentile":330.78,"90th_percentile":15818.48,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":20365.62,"10th_percentile":20365.62,"90th_percentile":20365.62,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":39165.7,"10th_percentile":39165.7,"90th_percentile":39165.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":109092.7,"10th_percentile":109092.7,"90th_percentile":109092.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"25","median_amount":870.83,"10th_percentile":455.06,"90th_percentile":16044.2,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":2450.0,"10th_percentile":810.33,"90th_percentile":15878.28,"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":"Other Circulatory System Diagnoses With Cc","code_information":[{"code":"315","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8233.64,"maximum":21717.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17125.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8398.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12213.68},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18525.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":18476.09},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13955.33},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":13955.33},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":18476.09},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8233.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":15872.29},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":21717.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8398.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8315.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8315.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17984.71},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":8233.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18784.35},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13530.51},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":18784.35},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8315.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8645.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8562.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8315.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"16","median_amount":389.13,"10th_percentile":362.1,"90th_percentile":7593.42,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":18815.56,"10th_percentile":18815.56,"90th_percentile":18815.56,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16085.71,"10th_percentile":16085.71,"90th_percentile":16085.71,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10214.34,"10th_percentile":10214.34,"90th_percentile":10214.34,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":362.1,"10th_percentile":362.1,"90th_percentile":7262.34,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13577.38,"10th_percentile":13577.38,"90th_percentile":14685.98,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_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":389.13,"10th_percentile":389.13,"90th_percentile":389.13,"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":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":504.5,"10th_percentile":504.5,"90th_percentile":7305.66,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_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":2742.37,"10th_percentile":2742.37,"90th_percentile":2742.37,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":2742.37,"10th_percentile":2742.37,"90th_percentile":2742.37,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18784.35,"10th_percentile":750.0,"90th_percentile":18784.35,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1050.0,"10th_percentile":362.1,"90th_percentile":7955.15,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"1 through 10","median_amount":7007.64,"10th_percentile":7007.64,"90th_percentile":76227.6,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":362.1,"10th_percentile":362.1,"90th_percentile":362.1,"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":"Other Circulatory System Diagnoses Without Cc/Mcc","code_information":[{"code":"316","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6000.99,"maximum":15377.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12482.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6121.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8648.35},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13502.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":13082.68},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9881.58},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":9881.58},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":13082.68},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6000.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":11238.96},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":15377.94},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6121.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6061.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6061.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12734.74},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":6000.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13300.95},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9580.78},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":13300.95},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6061.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6301.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6241.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6061.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":5333.01,"10th_percentile":5333.01,"90th_percentile":5333.01,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":530.26,"10th_percentile":530.26,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":4153.17,"10th_percentile":4153.17,"90th_percentile":4153.17,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":53674.35,"maximum":150747.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":111642.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54747.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":84778.13},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":120767.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":3697.3,"10th_percentile":3697.3,"90th_percentile":3697.3,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":129196.55,"10th_percentile":129196.55,"90th_percentile":129196.55,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":129176.39,"10th_percentile":129176.39,"90th_percentile":129176.39,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":97582.78,"10th_percentile":97582.78,"90th_percentile":97582.78,"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":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":49595.9,"10th_percentile":49595.9,"90th_percentile":57603.46,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":110989.21,"10th_percentile":110989.21,"90th_percentile":114067.81,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":50210.12,"10th_percentile":50210.12,"90th_percentile":50210.12,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"14","median_amount":44230.97,"10th_percentile":3501.86,"90th_percentile":50412.55,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":140540.82,"10th_percentile":140540.82,"90th_percentile":140540.82},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":14124.41,"10th_percentile":14124.41,"90th_percentile":14124.41,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":130386.75,"10th_percentile":130386.75,"90th_percentile":130386.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"1 through 10","median_amount":51677.65,"10th_percentile":51677.65,"90th_percentile":51677.65,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":3501.86,"10th_percentile":3501.86,"90th_percentile":22202.97,"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."}]}]},{"description":"Percutaneous Coronary Atherectomy Without Intraluminal Device","code_information":[{"code":"318","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19816.93,"maximum":54608.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41219.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20213.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":30711.07},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44588.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":46457.8},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35090.41},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":35090.41},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":46457.8},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19816.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":39910.59},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":54608.5},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20213.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20015.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20015.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":45222.23},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":19816.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":47232.9},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34022.22},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":47232.9},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20015.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20807.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20609.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20015.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":36019.55,"maximum":100616.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":74920.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36739.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":56585.11},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":81043.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":85598.42},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":64654.03},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":64654.03},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":85598.42},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36019.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":73535.2},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":100616.08},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36739.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36379.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36379.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":83321.9},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":36019.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":87026.55},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62685.89},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":87026.55},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36379.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37820.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37460.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36379.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":31621.34,"10th_percentile":31621.34,"90th_percentile":31621.34,"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."}]}]},{"description":"Other Endovascular Cardiac Valve Procedures Without Mcc","code_information":[{"code":"320","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19682.74,"maximum":54227.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40940.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20076.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":30496.8},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44286.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":46133.65},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34845.58},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":34845.58},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":46133.65},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19682.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":39632.13},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":54227.49},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20076.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19879.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19879.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":44906.71},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":19682.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":46903.35},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33784.84},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":46903.35},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19879.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20666.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20470.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19879.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":22187.73,"maximum":61340.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":46150.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22631.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":34497.02},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":49922.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":52184.94},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39416.23},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":39416.23},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":52184.94},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22187.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":44830.62},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":61340.44},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22631.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22409.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22409.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":50797.06},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":22187.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":53055.6},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38216.36},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":53055.6},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22409.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23297.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23075.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22409.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":1151.19,"10th_percentile":1071.21,"90th_percentile":21389.4,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":90182.79,"10th_percentile":90182.79,"90th_percentile":90182.79},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":50256.0,"10th_percentile":50256.0,"90th_percentile":50256.0,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":48031.94,"10th_percentile":46687.12,"90th_percentile":52571.3,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":84912.55,"10th_percentile":84912.55,"90th_percentile":84912.55,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33505.28,"10th_percentile":33505.28,"90th_percentile":33505.28,"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":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":1071.21,"10th_percentile":1071.21,"90th_percentile":20437.78,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":92302.13,"10th_percentile":92302.13,"90th_percentile":92302.13},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":13352.4,"10th_percentile":1071.21,"90th_percentile":21092.25,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"14","median_amount":1424.94,"10th_percentile":1071.21,"90th_percentile":20846.57,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":20627.49,"10th_percentile":1071.21,"90th_percentile":20821.78,"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."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc","code_information":[{"code":"322","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14583.05,"maximum":39746.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30332.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14874.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22353.08},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32811.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":33814.34},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25540.58},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":25540.58},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":33814.34},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14583.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":29048.95},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":39746.84},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14874.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14728.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14728.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":32915.03},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":14583.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":34378.5},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24763.1},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":34378.5},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14728.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15312.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15166.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14728.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":28140.86,"10th_percentile":28140.86,"90th_percentile":28140.86,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"38","median_amount":13390.37,"10th_percentile":680.78,"90th_percentile":13806.05,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1597.58,"10th_percentile":1597.58,"90th_percentile":28140.86,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":41581.01,"10th_percentile":31903.28,"90th_percentile":51949.37},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":32221.37,"10th_percentile":32026.64,"90th_percentile":33296.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32998.0,"10th_percentile":26884.47,"90th_percentile":32998.0,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23757.32,"10th_percentile":23138.01,"90th_percentile":25729.22,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"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":731.6,"10th_percentile":680.78,"90th_percentile":13307.0,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25825.63,"10th_percentile":24819.37,"90th_percentile":28423.38,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":13257.55,"10th_percentile":731.6,"90th_percentile":13410.76,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"15","median_amount":731.6,"10th_percentile":680.78,"90th_percentile":13360.9,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32903.92,"10th_percentile":32903.92,"90th_percentile":34378.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32903.92,"10th_percentile":32903.92,"90th_percentile":32903.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"31","median_amount":923.32,"10th_percentile":680.78,"90th_percentile":13396.63,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"25","median_amount":1405.83,"10th_percentile":680.78,"90th_percentile":13413.43,"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."}]}]},{"description":"Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc","code_information":[{"code":"323","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34943.72,"maximum":97561.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":72682.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35642.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":54867.1},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":78623.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":30795.06,"10th_percentile":2266.35,"90th_percentile":32508.0,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":56215.52,"10th_percentile":56215.52,"90th_percentile":56215.52,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"15","median_amount":2266.35,"10th_percentile":1602.75,"90th_percentile":32573.47,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5592.59,"10th_percentile":5592.59,"90th_percentile":5592.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":30992.18,"10th_percentile":1602.75,"90th_percentile":32896.03,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"1 through 10","median_amount":30548.19,"10th_percentile":30548.19,"90th_percentile":30548.19,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":32706.62,"10th_percentile":32706.62,"90th_percentile":32706.62,"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."}]}]},{"description":"Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc","code_information":[{"code":"324","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25603.41,"maximum":71039.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":53255.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26115.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":39951.53},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":57607.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":17263.61,"10th_percentile":17263.61,"90th_percentile":17263.61},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":55588.86,"10th_percentile":55588.86,"90th_percentile":55588.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"1 through 10","median_amount":38.85,"10th_percentile":38.85,"90th_percentile":38.85},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1650.24,"10th_percentile":1202.27,"90th_percentile":23618.93,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":43495.7,"10th_percentile":43495.7,"90th_percentile":43495.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Coronary Intravascular Lithotripsy Without Intraluminal Device","code_information":[{"code":"325","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26075.03,"maximum":72378.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":54236.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26596.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":40704.66},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":58668.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":40183.94,"maximum":112440.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":83582.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40987.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":63235.24},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":90413.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":93114.26},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":40183.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":97254.3},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":70053.02},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":97254.3},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40585.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42193.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41791.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40585.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":12588.0,"10th_percentile":12588.0,"90th_percentile":12588.0,"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":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":68449.75,"10th_percentile":68449.75,"90th_percentile":68449.75,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":72786.12,"10th_percentile":72786.12,"90th_percentile":72786.12,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":28602.57,"10th_percentile":28602.57,"90th_percentile":28602.57,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":77944.06,"10th_percentile":77944.06,"90th_percentile":77944.06,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":2612.0,"10th_percentile":2612.0,"90th_percentile":37453.1,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":2450.0,"10th_percentile":2053.83,"90th_percentile":48634.41,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":19991.6,"maximum":55104.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41582.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20391.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":30990.01},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44981.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":981.87,"10th_percentile":913.65,"90th_percentile":18649.23,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"1 through 10","median_amount":58192.03,"10th_percentile":58192.03,"90th_percentile":58192.03},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":54850.62,"10th_percentile":54850.62,"90th_percentile":54850.62},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":45609.82,"10th_percentile":45609.82,"90th_percentile":45609.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":17603.04,"10th_percentile":17603.04,"90th_percentile":17603.04,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28105.09,"10th_percentile":28105.09,"90th_percentile":28105.09,"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":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":17829.12,"10th_percentile":17829.12,"90th_percentile":17829.12,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":13307.13,"maximum":36123.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27678.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13573.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":20315.56},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29941.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"1 through 10","median_amount":36601.94,"10th_percentile":36601.94,"90th_percentile":36601.94},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":32353.26,"10th_percentile":32353.26,"90th_percentile":32353.26},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29063.85,"10th_percentile":29063.85,"90th_percentile":29063.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23383.97,"10th_percentile":23383.97,"90th_percentile":23383.97,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":644.38,"10th_percentile":644.38,"90th_percentile":11025.96,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24981.3,"10th_percentile":24981.3,"90th_percentile":24981.3,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_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":599.61,"10th_percentile":599.61,"90th_percentile":599.61,"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":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":11802.9,"10th_percentile":599.61,"90th_percentile":12133.03,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":10379.96,"10th_percentile":644.38,"90th_percentile":10383.4,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":37080.3,"maximum":103628.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":77127.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37821.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":58279.02},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":83430.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":88160.87},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":66589.5},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":66589.5},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":88160.87},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37080.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":75736.53},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":103628.09},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37821.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37451.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37451.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"11","median_amount":2636.0,"10th_percentile":768.16,"90th_percentile":35067.68,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":869.05,"10th_percentile":869.05,"90th_percentile":869.05,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":83751.66,"10th_percentile":83751.66,"90th_percentile":86313.57,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":63294.75,"10th_percentile":63294.75,"90th_percentile":63294.75,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":20087.09,"10th_percentile":1727.87,"90th_percentile":45257.76,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":71987.22,"10th_percentile":71987.22,"90th_percentile":76297.3,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":70004.79,"10th_percentile":70004.79,"90th_percentile":70004.79},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"19","median_amount":2407.28,"10th_percentile":1727.87,"90th_percentile":33384.29,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":135862.23,"10th_percentile":135862.23,"90th_percentile":135862.23,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":83512.89,"10th_percentile":83512.89,"90th_percentile":83512.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"23","median_amount":1908.0,"10th_percentile":1727.87,"90th_percentile":34699.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Major Small And Large Bowel Procedures With Cc","code_information":[{"code":"330","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19618.43,"maximum":54044.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40806.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20010.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":30394.1},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44141.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":45978.3},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34728.24},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":34728.24},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":45978.3},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19618.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":39498.66},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":54044.87},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20010.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19814.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19814.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":44755.48},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":19618.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":46745.4},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33671.07},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":46745.4},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19814.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20599.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20403.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19814.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":38994.68,"10th_percentile":38994.68,"90th_percentile":38994.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":43159.19,"10th_percentile":43159.19,"90th_percentile":43159.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":41508.47,"10th_percentile":37055.72,"90th_percentile":42452.19,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32581.24,"10th_percentile":29861.28,"90th_percentile":34984.74,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32581.24,"10th_percentile":32581.24,"90th_percentile":32581.24,"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":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"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":955.83,"10th_percentile":889.43,"90th_percentile":16904.49,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36805.72,"10th_percentile":36455.72,"90th_percentile":39102.99,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":78943.18,"10th_percentile":78943.18,"90th_percentile":78943.18},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"22","median_amount":1100.0,"10th_percentile":889.43,"90th_percentile":17372.75,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":47045.4,"10th_percentile":47045.4,"90th_percentile":47045.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33200.53,"10th_percentile":33200.53,"90th_percentile":33200.53,"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":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"22","median_amount":1046.18,"10th_percentile":780.25,"90th_percentile":17371.08,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"1 through 10","median_amount":16205.35,"10th_percentile":16205.35,"90th_percentile":16205.35,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":15415.39,"10th_percentile":889.43,"90th_percentile":17397.48,"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":"Major Small And Large Bowel Procedures Without Cc/Mcc","code_information":[{"code":"331","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13947.08,"maximum":37940.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29009.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14226.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":21337.49},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31380.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":32278.02},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24380.17},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":24380.17},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":32278.02},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13947.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":27729.14},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":37940.98},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14226.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14086.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14086.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":31419.57},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":13947.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":32816.55},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23638.01},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":32816.55},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14086.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14644.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14504.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14086.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":26377.85,"10th_percentile":26265.03,"90th_percentile":27031.03,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":12380.31,"10th_percentile":621.25,"90th_percentile":22115.83,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20933.03,"10th_percentile":20933.03,"90th_percentile":20933.03,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":56584.79,"10th_percentile":56584.79,"90th_percentile":59429.25},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":29707.16,"10th_percentile":29707.16,"90th_percentile":29707.16,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30112.59,"10th_percentile":30112.59,"90th_percentile":30112.59,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21183.9,"10th_percentile":21096.78,"90th_percentile":24560.24,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22753.51,"10th_percentile":22753.51,"90th_percentile":22753.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":881.37,"10th_percentile":667.62,"90th_percentile":11685.4,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25882.73,"10th_percentile":19882.73,"90th_percentile":27784.46,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":55063.92,"10th_percentile":2361.82,"90th_percentile":78610.77},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":975.0,"10th_percentile":621.25,"90th_percentile":13621.65,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":5403.51,"10th_percentile":5403.51,"90th_percentile":5403.51,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30026.74,"10th_percentile":30026.74,"90th_percentile":30026.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":881.37,"10th_percentile":621.25,"90th_percentile":13084.71,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"1 through 10","median_amount":12084.52,"10th_percentile":12084.52,"90th_percentile":12084.52,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":12150.39,"10th_percentile":667.62,"90th_percentile":13078.5,"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":"Rectal Resection With Mcc","code_information":[{"code":"332","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29332.7,"maximum":81628.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":61012.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29919.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":45906.86},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":65998.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":69445.03},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52453.08},{"payer_name":"Blue Cross","plan_name":"Health Options - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":28937.3,"maximum":80505.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":60189.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29516.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":45275.44},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":65108.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":68489.86},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":51731.63},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":51731.63},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":68489.86},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28937.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":58837.72},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":80505.94},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29516.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29226.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29226.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":66668.35},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":28937.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":69632.55},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":50156.86},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":69632.55},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29226.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30384.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30094.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29226.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":55499.81,"10th_percentile":55499.81,"90th_percentile":55499.81,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":77382.07,"10th_percentile":77382.07,"90th_percentile":77382.07,"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":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":24202.27,"10th_percentile":24202.27,"90th_percentile":24202.27,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":12322.15,"10th_percentile":12322.15,"90th_percentile":14737.4,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1007.78,"10th_percentile":1007.78,"90th_percentile":1007.78,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":5274.88,"10th_percentile":1363.43,"90th_percentile":26422.1,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":17327.82,"maximum":47540.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36041.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17674.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":26736.21},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38987.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":40444.87},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30548.74},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":30548.74},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":40444.87},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17327.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":34745.05},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":47540.64},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17674.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17501.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17501.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":30736.76,"10th_percentile":30736.76,"90th_percentile":30736.76},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":40486.31,"10th_percentile":40486.31,"90th_percentile":40486.31,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28108.34,"10th_percentile":28108.34,"90th_percentile":28108.34,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":14717.2,"10th_percentile":854.17,"90th_percentile":15317.39,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32348.05,"10th_percentile":32348.05,"90th_percentile":32348.05,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":854.17,"10th_percentile":854.17,"90th_percentile":15527.55,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":40198.14,"10th_percentile":40198.14,"90th_percentile":40198.14},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":19924.7,"10th_percentile":19924.7,"90th_percentile":19924.7,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1104.37,"10th_percentile":318.0,"90th_percentile":17974.67,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1580.0,"10th_percentile":1580.0,"90th_percentile":15593.14,"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":"Peritoneal Adhesiolysis Without Cc/Mcc","code_information":[{"code":"337","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12772.79,"maximum":34606.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26567.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13028.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19462.27},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28738.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":29441.3},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22237.55},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":22237.55},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":29441.3},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12772.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":25292.2},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":34606.58},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13028.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12900.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12900.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":28658.3},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":12772.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29932.5},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21560.61},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":29932.5},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12900.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13411.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13283.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12900.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":2544.0,"10th_percentile":803.91,"90th_percentile":12396.97,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":27509.18,"10th_percentile":27509.18,"90th_percentile":27509.18,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":803.91,"10th_percentile":803.91,"90th_percentile":803.91,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27918.86,"10th_percentile":27918.86,"90th_percentile":27918.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":21092.05,"maximum":58229.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43871.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21513.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":32747.32},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":47457.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":49538.1},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37417.02},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":37417.02},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":49538.1},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21092.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":42556.8},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":58229.23},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21513.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21302.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21302.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":48220.62},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":21092.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":50364.6},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36278.01},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":50364.6},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21302.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22146.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21935.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21302.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":19741.44,"10th_percentile":19741.44,"90th_percentile":19741.44,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":12532.22,"maximum":33923.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26067.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12782.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19078.09},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28197.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":28860.15},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21798.59},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":21798.59},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":28860.15},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12532.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":24792.94},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":33923.46},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12782.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12657.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12657.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":28092.6},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":12532.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29341.65},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21135.02},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":29341.65},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12657.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13158.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13033.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12657.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":24687.67,"10th_percentile":24687.67,"90th_percentile":24687.67,"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":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":10003.41,"maximum":26742.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20807.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10203.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15039.83},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22507.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":22751.32},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17184.48},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":17184.48},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":22751.32},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10003.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":19545.02},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":26742.88},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10203.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10103.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10103.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22146.24},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":10003.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23130.9},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16661.37},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":23130.9},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10103.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10503.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10403.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10103.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18022.57,"10th_percentile":18022.57,"90th_percentile":18022.57,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":621.24,"10th_percentile":621.24,"90th_percentile":621.24,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":18811.75,"maximum":51754.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39128.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19187.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":29105.91},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42326.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":44029.61},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33256.36},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":33256.36},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":44029.61},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18811.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":37824.6},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":51754.3},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19187.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18999.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18999.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":42858.62},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":18811.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":44764.2},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32244.0},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":44764.2},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18999.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19752.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19564.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18999.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":10976.82,"maximum":29506.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22831.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11196.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16594.28},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24697.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":25102.78},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18960.59},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":18960.59},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":25102.78},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10976.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":21565.1},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":29506.9},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11196.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11086.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11086.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":24435.17},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":10976.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25521.6},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18383.4},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":25521.6},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11086.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11525.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11415.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11086.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12632.58,"10th_percentile":12632.58,"90th_percentile":12632.58,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":10504.02,"10th_percentile":10504.02,"90th_percentile":10504.02,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":7497.63,"maximum":19627.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15595.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7647.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11038.34},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16869.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":16698.11},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12612.38},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":12612.38},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":16698.11},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7497.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":14344.88},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":19627.68},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7647.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7572.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7572.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16254.01},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":7497.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16976.7},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12228.45},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":16976.7},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7572.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7872.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7797.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7572.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":20370.33,"maximum":56179.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42370.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20777.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":31594.8},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45833.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":47794.64},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36100.16},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":36100.16},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":47794.64},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20370.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":41059.04},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":56179.89},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20777.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20574.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20574.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":46523.52},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":20370.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":48592.05},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35001.23},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":48592.05},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20574.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21388.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21185.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20574.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":19302.91,"10th_percentile":19302.91,"90th_percentile":19302.91,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":17601.16,"10th_percentile":17601.16,"90th_percentile":17601.16,"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."}]}]},{"description":"Inguinal And Femoral Hernia Procedures With Cc","code_information":[{"code":"351","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12689.42,"maximum":34369.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26393.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12943.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19329.14},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28551.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":29239.91},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22085.43},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":22085.43},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":29239.91},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12689.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":25119.19},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":34369.85},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12943.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12816.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12816.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":28462.26},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":12689.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29727.75},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21413.13},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":29727.75},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12816.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13323.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13197.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12816.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":798.42,"10th_percentile":798.42,"90th_percentile":11198.05,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":10170.66,"10th_percentile":10170.66,"90th_percentile":10170.66,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"1 through 10","median_amount":39578.98,"10th_percentile":39578.98,"90th_percentile":39578.98},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":11205.2,"10th_percentile":11205.2,"90th_percentile":11205.2,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"1 through 10","median_amount":9913.46,"10th_percentile":9913.46,"90th_percentile":9913.46,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":9857.32,"maximum":26328.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20503.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10054.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14806.54},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22178.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"1 through 10","median_amount":8083.63,"10th_percentile":8083.63,"90th_percentile":8083.63},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":23626.41,"maximum":65425.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":49142.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24098.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":36794.46},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":53159.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":55660.36},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42041.27},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":42041.27},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":55660.36},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23626.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":47816.25},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":65425.59},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24098.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23862.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23862.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":54180.05},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":23626.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":56589.0},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40761.49},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":56589.0},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23862.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24807.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24571.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23862.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":45083.63,"10th_percentile":45083.63,"90th_percentile":45083.63,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":51613.64,"10th_percentile":51613.64,"90th_percentile":51613.64,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":22119.53,"10th_percentile":22119.53,"90th_percentile":22119.53,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"1 through 10","median_amount":22768.56,"10th_percentile":22768.56,"90th_percentile":22768.56,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":13943.11,"maximum":37929.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29001.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14221.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":21331.15},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31372.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":12190.46,"10th_percentile":12190.46,"90th_percentile":12190.46,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25311.23,"10th_percentile":25311.23,"90th_percentile":25311.23,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":10544.42,"10th_percentile":881.11,"90th_percentile":12573.13,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":12635.82,"10th_percentile":12635.82,"90th_percentile":12635.82,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":12616.35,"10th_percentile":12616.35,"90th_percentile":12616.35,"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."}]}]},{"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":11264.24,"maximum":30323.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23429.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11489.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17053.26},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25344.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18950.51,"10th_percentile":18950.51,"90th_percentile":18950.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":9957.9,"10th_percentile":9957.9,"90th_percentile":9957.9,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":4596.14,"10th_percentile":4596.14,"90th_percentile":4596.14,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24564.91,"10th_percentile":24564.91,"90th_percentile":24564.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17188.22,"10th_percentile":17188.22,"90th_percentile":17188.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":77802.1,"10th_percentile":77802.1,"90th_percentile":77802.1,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":12180.21,"10th_percentile":12180.21,"90th_percentile":12180.21,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":67846.32,"10th_percentile":67846.32,"90th_percentile":67846.32,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":59143.05,"10th_percentile":59143.05,"90th_percentile":59143.05,"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":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":2640.0,"10th_percentile":2640.0,"90th_percentile":2640.0,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"1 through 10","median_amount":31442.88,"10th_percentile":31442.88,"90th_percentile":31442.88,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":30711.1,"10th_percentile":30711.1,"90th_percentile":30711.1,"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":"Other Digestive System O.R. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":847.4,"10th_percentile":847.4,"90th_percentile":23097.13,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":16912.77,"10th_percentile":1217.91,"90th_percentile":18453.32,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":16620.76,"10th_percentile":1217.91,"90th_percentile":17860.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Other Digestive System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"358","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11684.25,"maximum":31515.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24303.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11917.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17723.97},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26289.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":26811.72},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20251.38},{"payer_name":"Blue Cross","plan_name":"Health Options - 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Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26098.65},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":11684.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":27259.05},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19634.9},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":27259.05},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11801.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12268.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12151.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11801.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21243.9,"10th_percentile":21243.9,"90th_percentile":21243.9,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18078.7,"10th_percentile":18078.7,"90th_percentile":18078.7,"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":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":4412.46,"10th_percentile":4412.46,"90th_percentile":4412.46,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":27886.88,"maximum":77523.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":58004.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28444.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":43598.01},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62745.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":65952.35},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":49815.0},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":49815.0},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":65952.35},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27886.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":56657.81},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":77523.24},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28444.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28165.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28165.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":64198.32},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":27886.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":67052.7},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48298.58},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":67052.7},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28165.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29281.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29002.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28165.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc","code_information":[{"code":"360","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19754.2,"maximum":54430.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41088.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20149.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":30610.91},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44446.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":46306.27},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34975.96},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":34975.96},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":46306.27},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19754.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":39780.42},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":54430.39},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20149.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19951.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19951.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":45074.74},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":19754.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":47078.85},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33911.26},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":47078.85},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19951.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20741.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20544.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19951.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":45249.1,"10th_percentile":45249.1,"90th_percentile":45249.1,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":774.23,"10th_percentile":774.23,"90th_percentile":774.23,"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":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":18491.97,"10th_percentile":18491.97,"90th_percentile":18491.97,"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."}]}]},{"description":"Major Esophageal Disorders With Mcc","code_information":[{"code":"368","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13224.56,"maximum":35889.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27507.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13489.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":20183.7},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29755.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":30532.64},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23061.86},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":23061.86},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":30532.64},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13224.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":26229.74},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":35889.39},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13489.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13356.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13356.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26180.59,"10th_percentile":26180.59,"90th_percentile":26180.59,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":833.72,"10th_percentile":833.72,"90th_percentile":833.72,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":7763.41,"10th_percentile":7763.41,"90th_percentile":7763.41,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":12407.07,"10th_percentile":12407.07,"90th_percentile":12407.07,"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."}]}]},{"description":"Major Esophageal Disorders With Cc","code_information":[{"code":"369","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8526.62,"maximum":22549.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17735.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8697.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12681.54},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19184.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":19160.44,"10th_percentile":19160.44,"90th_percentile":19160.44,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":21563.05,"10th_percentile":21563.05,"90th_percentile":21563.05},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":382.91,"10th_percentile":382.91,"90th_percentile":7715.79,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":4114.1,"10th_percentile":4114.1,"90th_percentile":4114.1,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":6262.71,"10th_percentile":6262.71,"90th_percentile":6262.71,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":6149.46,"maximum":15799.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12790.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6272.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8885.44},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13836.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10227.48,"10th_percentile":10227.48,"90th_percentile":10227.48,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12694.53,"10th_percentile":12694.53,"90th_percentile":12694.53,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":14663.24,"maximum":39974.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30499.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14956.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22481.13},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32992.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":34008.06},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25686.9},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":25686.9},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":34008.06},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14663.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":29215.37},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":39974.54},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14956.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14809.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14809.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24094.43,"10th_percentile":24094.43,"90th_percentile":24094.43,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":706.85,"10th_percentile":706.85,"90th_percentile":11943.63,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26803.4,"10th_percentile":26803.4,"90th_percentile":26803.4,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":12919.98,"10th_percentile":706.85,"90th_percentile":14235.48,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":4134.23,"10th_percentile":4134.23,"90th_percentile":4134.23,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31790.88,"10th_percentile":31790.88,"90th_percentile":31790.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20132.25,"10th_percentile":20132.25,"90th_percentile":20132.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":11610.27,"10th_percentile":657.75,"90th_percentile":12961.67,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":12867.74,"10th_percentile":12867.74,"90th_percentile":12867.74,"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."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections With Cc","code_information":[{"code":"372","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8691.76,"maximum":23018.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18078.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8865.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12945.26},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19556.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":19582.78},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14791.23},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":14791.23},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":19582.78},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8691.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":16823.02},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":23018.45},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8865.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8778.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8778.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19061.97},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":8691.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19909.5},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14340.97},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":19909.5},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8778.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9126.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9039.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8778.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":11782.06,"10th_percentile":11782.06,"90th_percentile":11782.06,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":8250.11,"10th_percentile":8250.11,"90th_percentile":8250.11,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13050.49,"10th_percentile":13050.49,"90th_percentile":13050.49,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":18383.51,"10th_percentile":18383.51,"90th_percentile":18383.51},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":18703.53,"10th_percentile":18703.53,"90th_percentile":18703.53,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13102.92,"10th_percentile":13102.92,"90th_percentile":13102.92,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13236.95,"10th_percentile":12412.87,"90th_percentile":14187.87,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":387.31,"10th_percentile":387.31,"90th_percentile":8109.93,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16136.34,"10th_percentile":16136.34,"90th_percentile":18342.71,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":17270.88,"10th_percentile":17270.88,"90th_percentile":17270.88},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":7786.17,"10th_percentile":387.31,"90th_percentile":7786.17,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":387.31,"10th_percentile":387.31,"90th_percentile":4490.0,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":20162.05,"10th_percentile":20162.05,"90th_percentile":20162.05},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":2692.41,"10th_percentile":2692.41,"90th_percentile":2692.41,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":4092.46,"10th_percentile":4092.46,"90th_percentile":4397.06,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18719.88,"10th_percentile":18719.88,"90th_percentile":18719.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":6241.12,"10th_percentile":387.31,"90th_percentile":9078.56,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"1 through 10","median_amount":6991.85,"10th_percentile":6991.85,"90th_percentile":6991.85,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":387.31,"10th_percentile":209.34,"90th_percentile":7817.77,"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."}]}]},{"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":6360.66,"maximum":16399.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13230.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6487.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9222.7},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14311.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":13951.53},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10537.84},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":10537.84},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":13951.53},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6360.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":11985.37},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":16399.23},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6487.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6424.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6424.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13580.49},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":6360.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14184.3},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10217.06},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":14184.3},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6424.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6678.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6615.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6424.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":954.0,"10th_percentile":954.0,"90th_percentile":954.0,"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":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":380.96,"10th_percentile":380.96,"90th_percentile":6954.15,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":13589.24,"10th_percentile":13589.24,"90th_percentile":13589.24,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1906.82,"10th_percentile":1906.82,"90th_percentile":1906.82,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9267.73,"10th_percentile":9267.73,"90th_percentile":9267.73,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":5815.82,"10th_percentile":5815.82,"90th_percentile":5815.82,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":1907.91,"10th_percentile":1907.91,"90th_percentile":1907.91,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14145.3,"10th_percentile":14145.3,"90th_percentile":14145.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":272.96,"10th_percentile":272.96,"90th_percentile":272.96,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":17566.01,"maximum":48216.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36537.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17917.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":27116.58},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39523.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":794.49,"10th_percentile":794.49,"90th_percentile":794.49,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29103.54,"10th_percentile":29103.54,"90th_percentile":29103.54,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":12469.95,"10th_percentile":12469.95,"90th_percentile":15311.03,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30269.93,"10th_percentile":30269.93,"90th_percentile":33100.42,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_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":5045.48,"10th_percentile":5045.48,"90th_percentile":5045.48,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28653.81,"10th_percentile":28653.81,"90th_percentile":28653.81,"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":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1120.08,"10th_percentile":1120.08,"90th_percentile":1120.08,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":7212.3,"10th_percentile":7212.3,"90th_percentile":7212.3,"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":"Digestive Malignancy With Cc","code_information":[{"code":"375","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10189.2,"maximum":27270.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21193.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10392.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15336.52},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22925.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":23200.13},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17523.48},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":17523.48},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":23200.13},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10189.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":19930.58},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":27270.43},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10392.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10291.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10291.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22583.11},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":10189.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23587.2},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16990.04},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":23587.2},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10291.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10698.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10596.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10291.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":9324.23,"10th_percentile":9324.23,"90th_percentile":9324.23,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20140.26,"10th_percentile":20140.26,"90th_percentile":20140.26,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15773.56,"10th_percentile":15773.56,"90th_percentile":15773.56,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":749.31,"10th_percentile":749.31,"90th_percentile":749.31,"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":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":7954.77,"10th_percentile":7954.77,"90th_percentile":7954.77,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15608.67,"10th_percentile":15608.67,"90th_percentile":15608.67,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":49644.98,"10th_percentile":49644.98,"90th_percentile":49644.98},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":7448.02,"10th_percentile":7448.02,"90th_percentile":9143.08,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":3560.88,"10th_percentile":3560.88,"90th_percentile":3560.88,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22346.37,"10th_percentile":22346.37,"90th_percentile":22346.37,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":7882.67,"10th_percentile":633.49,"90th_percentile":9561.52,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":9221.72,"10th_percentile":9221.72,"90th_percentile":9221.72,"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."}]}]},{"description":"Digestive Malignancy Without Cc/Mcc","code_information":[{"code":"376","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7923.99,"maximum":20838.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16481.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8082.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11719.2},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17828.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":15099.13,"maximum":41212.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31406.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15401.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":23177.21},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33973.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":35061.04},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26482.24},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":26482.24},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":35061.04},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15099.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":30119.96},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":41212.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15401.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15250.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15250.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":64604.66,"10th_percentile":64604.66,"90th_percentile":64604.66},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":32362.74,"10th_percentile":32267.3,"90th_percentile":32376.06,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23517.47,"10th_percentile":23517.47,"90th_percentile":23517.47,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":684.16,"10th_percentile":684.16,"90th_percentile":14064.8,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24207.18,"10th_percentile":24207.18,"90th_percentile":30260.06,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":43557.5,"10th_percentile":43557.5,"90th_percentile":43557.5},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":13450.05,"10th_percentile":13450.05,"90th_percentile":13450.05,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"26","median_amount":2994.25,"10th_percentile":684.16,"90th_percentile":16011.33,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":7506.03,"10th_percentile":7506.03,"90th_percentile":7506.03,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":4483.66,"10th_percentile":4483.66,"90th_percentile":4483.66,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"32","median_amount":957.36,"10th_percentile":684.16,"90th_percentile":13776.4,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":13366.61,"10th_percentile":735.24,"90th_percentile":13481.64,"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."}]}]},{"description":"Gastrointestinal Hemorrhage With Cc","code_information":[{"code":"378","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8371.79,"maximum":22109.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17413.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8539.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12434.3},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18836.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":18809.83},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14207.4},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":14207.4},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":18809.83},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8371.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":16158.99},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":22109.88},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8539.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8455.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8455.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18309.57},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":8371.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19123.65},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13774.91},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":19123.65},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8455.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8790.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8706.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8455.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"43","median_amount":398.67,"10th_percentile":370.98,"90th_percentile":7873.59,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12434.3,"10th_percentile":8072.72,"90th_percentile":15707.35,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":7409.52,"10th_percentile":7409.52,"90th_percentile":7409.52,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17343.45,"10th_percentile":17343.45,"90th_percentile":18949.09,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13089.65,"10th_percentile":12236.41,"90th_percentile":13589.65,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"24","median_amount":370.98,"10th_percentile":370.98,"90th_percentile":7180.78,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13910.35,"10th_percentile":12559.77,"90th_percentile":15455.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":42047.9,"10th_percentile":42047.9,"90th_percentile":42047.9},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"1 through 10","median_amount":36460.45,"10th_percentile":36460.45,"90th_percentile":36460.45},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_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":370.98,"10th_percentile":370.98,"90th_percentile":370.98,"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":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"1 through 10","median_amount":5202.8,"10th_percentile":5202.8,"90th_percentile":5202.8,"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":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"44","median_amount":513.61,"10th_percentile":370.98,"90th_percentile":7566.08,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":2615.84,"10th_percentile":2615.84,"90th_percentile":2615.84,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13379.65,"10th_percentile":13379.65,"90th_percentile":17930.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"58","median_amount":398.67,"10th_percentile":370.98,"90th_percentile":7488.26,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"12","median_amount":398.67,"10th_percentile":370.98,"90th_percentile":7491.75,"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."}]}]},{"description":"Gastrointestinal Hemorrhage Without Cc/Mcc","code_information":[{"code":"379","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5590.5,"maximum":14212.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11628.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5702.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":7992.84},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12578.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":12091.07},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9132.6},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":9132.6},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":12091.07},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5590.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":10387.1},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":14212.37},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5702.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5646.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5646.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11769.5},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":5590.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12292.8},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8854.6},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":12292.8},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5646.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5870.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5814.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5646.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":5034.57,"10th_percentile":239.58,"90th_percentile":6429.7,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":239.58,"10th_percentile":239.58,"90th_percentile":239.58,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":330.15,"10th_percentile":239.58,"90th_percentile":1881.53,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":239.58,"10th_percentile":239.58,"90th_percentile":239.58,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":16164.65,"maximum":44237.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33622.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16487.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":24878.73},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36370.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":37635.0},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28426.39},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":28426.39},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":37635.0},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16164.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":32331.17},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":44237.8},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16487.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16326.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16326.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":36634.08},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":16164.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":38262.9},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27561.06},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":38262.9},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16326.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16972.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16811.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16326.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":778.15,"10th_percentile":778.15,"90th_percentile":778.15,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28636.35,"10th_percentile":28636.35,"90th_percentile":28636.35,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_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":724.08,"10th_percentile":724.08,"90th_percentile":724.08,"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":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1027.65,"10th_percentile":1027.65,"90th_percentile":14191.0,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":14071.63,"10th_percentile":14071.63,"90th_percentile":14071.63,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":9188.0,"maximum":24427.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19111.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9371.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13737.7},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20673.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":20781.53},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15696.66},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":15696.66},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":20781.53},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9188.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":17852.83},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":24427.51},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9371.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9279.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9279.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20228.84},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":9188.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21128.25},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15218.84},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":21128.25},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9279.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9647.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9555.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9279.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":8296.85,"10th_percentile":8296.85,"90th_percentile":8296.85,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13808.7,"10th_percentile":13808.7,"90th_percentile":13808.7,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":7218.5,"10th_percentile":7218.5,"90th_percentile":7218.5,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17985.02,"10th_percentile":17985.02,"90th_percentile":19864.09,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"11","median_amount":567.45,"10th_percentile":440.41,"90th_percentile":8144.09,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":2803.12,"10th_percentile":2803.12,"90th_percentile":2803.12,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18560.71,"10th_percentile":18560.71,"90th_percentile":18560.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":621.57,"10th_percentile":409.82,"90th_percentile":6853.17,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":6941.84,"maximum":18049.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14439.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7080.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10150.81},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15619.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":15355.51},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11598.29},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":11598.29},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":15355.51},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6941.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":13191.49},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":18049.53},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7080.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7011.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7011.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14947.12},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":6941.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15611.7},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11245.23},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":15611.7},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7011.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7288.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7219.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7011.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2597.0,"10th_percentile":2597.0,"90th_percentile":2597.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":11547.69,"maximum":31127.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24019.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11778.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17505.9},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25982.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":26481.83},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20002.2},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":20002.2},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":26481.83},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11547.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":22749.79},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":31127.88},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11778.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11663.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11663.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25777.53},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":11547.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26923.65},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19393.31},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":26923.65},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11663.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12125.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12009.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11663.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":7372.18,"maximum":19271.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15334.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7519.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10838.01},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16587.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":16395.06},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12383.49},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":12383.49},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":16395.06},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7372.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":14084.54},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":19271.47},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7519.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7445.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7445.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15959.03},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":7372.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16668.6},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12006.52},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":16668.6},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7445.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7740.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7667.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7445.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":1952.0,"10th_percentile":1952.0,"90th_percentile":1952.0,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9072.61,"10th_percentile":9072.61,"90th_percentile":9072.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_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":327.22,"10th_percentile":327.22,"90th_percentile":327.22,"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":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - 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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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":11516.39,"10th_percentile":11516.39,"90th_percentile":11516.39,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23121.99,"10th_percentile":23121.99,"90th_percentile":23121.99,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":4764.59,"10th_percentile":828.69,"90th_percentile":12343.51,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30186.24,"10th_percentile":30186.24,"90th_percentile":30186.24,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":6266.0,"10th_percentile":611.39,"90th_percentile":12205.46,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":8336.86,"maximum":22010.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17340.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8503.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12378.51},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18757.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":21604.61,"10th_percentile":15586.91,"90th_percentile":24903.68},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":18293.83,"10th_percentile":18293.83,"90th_percentile":18398.59,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11821.2,"10th_percentile":11821.2,"90th_percentile":11821.2,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":6716.03,"10th_percentile":401.35,"90th_percentile":7227.9,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15559.42,"10th_percentile":15552.22,"90th_percentile":16205.6,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":14174.05,"10th_percentile":14174.05,"90th_percentile":16999.61},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":7526.47,"10th_percentile":7526.47,"90th_percentile":7526.47,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":7535.94,"10th_percentile":7535.94,"90th_percentile":7535.94,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":2877.17,"10th_percentile":2877.17,"90th_percentile":4425.04,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8146.97,"10th_percentile":8146.97,"90th_percentile":19353.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6564.6,"10th_percentile":6564.6,"90th_percentile":6564.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":7250.06,"10th_percentile":373.46,"90th_percentile":7521.98,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":5994.63,"maximum":15359.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12468.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6114.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8638.2},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13487.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8638.2,"10th_percentile":8638.2,"90th_percentile":8638.2,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":20838.15,"10th_percentile":20838.15,"90th_percentile":20838.15},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":12968.26,"10th_percentile":12968.26,"90th_percentile":12968.26,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7643.52,"10th_percentile":7643.52,"90th_percentile":7643.52,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":23294.05,"10th_percentile":23294.05,"90th_percentile":23294.05},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":550.0,"10th_percentile":550.0,"90th_percentile":567.0,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13285.35,"10th_percentile":13285.35,"90th_percentile":13285.35,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":5173.92,"10th_percentile":271.06,"90th_percentile":5214.74,"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."}]}]},{"description":"Gastrointestinal Obstruction With Mcc","code_information":[{"code":"388","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12310.7,"maximum":33294.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25606.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12556.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18724.35},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27699.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":28325.02},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21394.4},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":21394.4},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":28325.02},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12310.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":24333.23},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":33294.46},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12556.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12433.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12433.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":27571.71},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":12310.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":28797.6},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20743.13},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":28797.6},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12433.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12926.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12803.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12433.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":10972.54,"10th_percentile":553.1,"90th_percentile":11684.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24513.4,"10th_percentile":24513.4,"90th_percentile":24513.4,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"1 through 10","median_amount":23370.32,"10th_percentile":23370.32,"90th_percentile":23370.32},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":687.5,"10th_percentile":553.1,"90th_percentile":10950.88,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":8629.19,"10th_percentile":8629.19,"90th_percentile":8629.19,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19948.01,"10th_percentile":19948.01,"90th_percentile":19948.01,"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":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":594.4,"10th_percentile":553.1,"90th_percentile":11177.74,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"1 through 10","median_amount":10466.17,"10th_percentile":773.44,"90th_percentile":10961.59,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":10998.44,"10th_percentile":10998.44,"90th_percentile":10998.44,"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."}]}]},{"description":"Gastrointestinal Obstruction With Cc","code_information":[{"code":"389","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6856.1,"maximum":17806.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14260.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6993.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10013.87},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15426.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":15148.36},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11441.83},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":11441.83},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":15148.36},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6856.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":13013.53},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":17806.04},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6993.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6924.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6924.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14745.49},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":6856.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15401.1},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11093.53},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":15401.1},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6924.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7198.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7130.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6924.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":12926.78,"10th_percentile":9724.6,"90th_percentile":13758.06,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"17","median_amount":324.15,"10th_percentile":301.63,"90th_percentile":6222.13,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7638.95,"10th_percentile":7638.95,"90th_percentile":7638.95,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":15032.63,"10th_percentile":14923.17,"90th_percentile":15819.59,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14220.38,"10th_percentile":12909.51,"90th_percentile":14620.38,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11146.06,"10th_percentile":10358.77,"90th_percentile":11526.34,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":5080.36,"10th_percentile":301.63,"90th_percentile":6117.92,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10566.68,"10th_percentile":6148.35,"90th_percentile":10566.68,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"16","median_amount":413.64,"10th_percentile":301.63,"90th_percentile":7159.42,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":2447.92,"10th_percentile":2447.92,"90th_percentile":2447.92,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"36","median_amount":324.15,"10th_percentile":301.63,"90th_percentile":6179.42,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"15","median_amount":1750.0,"10th_percentile":301.63,"90th_percentile":6179.41,"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."}]}]},{"description":"Gastrointestinal Obstruction Without Cc/Mcc","code_information":[{"code":"390","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4904.51,"maximum":12264.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10201.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5002.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":6897.38},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11035.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":10433.92},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7880.93},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":7880.93},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":10433.92},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4904.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":8963.49},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":12264.48},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5002.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4953.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4953.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10156.43},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":4904.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10608.0},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7641.02},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":10608.0},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4953.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5149.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5100.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4953.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":9088.6,"10th_percentile":9088.6,"90th_percentile":9088.6,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":221.27,"10th_percentile":205.91,"90th_percentile":5644.77,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6937.95,"10th_percentile":6937.95,"90th_percentile":8960.68,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":4865.7,"10th_percentile":4865.7,"90th_percentile":4865.7},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":10416.94,"10th_percentile":10416.94,"90th_percentile":10521.7,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6662.76,"10th_percentile":6083.23,"90th_percentile":8982.35,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5808.08,"10th_percentile":5808.08,"90th_percentile":12355.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":3659.61,"10th_percentile":205.91,"90th_percentile":3979.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7078.45,"10th_percentile":6641.02,"90th_percentile":8578.45,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"1 through 10","median_amount":10835.52,"10th_percentile":10835.52,"90th_percentile":10835.52},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":414.55,"10th_percentile":205.91,"90th_percentile":4334.3,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":17120.8,"10th_percentile":17120.8,"90th_percentile":17120.8},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":1773.61,"10th_percentile":1773.61,"90th_percentile":1830.91,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9951.93,"10th_percentile":9951.93,"90th_percentile":10608.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10670.4,"10th_percentile":10670.4,"90th_percentile":10670.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":4329.56,"10th_percentile":205.91,"90th_percentile":4960.96,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":4338.96,"10th_percentile":205.91,"90th_percentile":4359.96,"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."}]}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc","code_information":[{"code":"391","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10655.26,"maximum":28593.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22162.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10868.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16080.78},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23974.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12497.36,"10th_percentile":12497.36,"90th_percentile":38207.84,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"1 through 10","median_amount":29375.83,"10th_percentile":29375.83,"90th_percentile":29375.83},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":24922.26,"10th_percentile":24922.26,"90th_percentile":24922.26,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23428.0,"10th_percentile":23428.0,"90th_percentile":23428.0,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17705.55,"10th_percentile":17705.55,"90th_percentile":17705.55,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12832.72,"10th_percentile":12832.72,"90th_percentile":12832.72,"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":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"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":8701.01,"10th_percentile":483.34,"90th_percentile":9566.12,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19537.11,"10th_percentile":18478.93,"90th_percentile":20352.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":68644.42,"10th_percentile":68644.42,"90th_percentile":68644.42},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":9626.17,"10th_percentile":9626.17,"90th_percentile":9626.17,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"20","median_amount":664.23,"10th_percentile":483.34,"90th_percentile":9976.36,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":40555.63,"10th_percentile":40555.63,"90th_percentile":40555.63},{"payer_name":"Molina","plan_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":3394.45,"10th_percentile":3394.45,"90th_percentile":3394.45,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":2885.44,"10th_percentile":2885.44,"90th_percentile":2885.44,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25587.2,"10th_percentile":25587.2,"90th_percentile":25587.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17814.54,"10th_percentile":17814.54,"90th_percentile":17814.54,"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":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"23","median_amount":519.42,"10th_percentile":483.34,"90th_percentile":9542.31,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"1 through 10","median_amount":9904.07,"10th_percentile":9904.07,"90th_percentile":9904.07,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":9607.42,"10th_percentile":483.34,"90th_percentile":9646.37,"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."}]}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc","code_information":[{"code":"392","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6775.11,"maximum":17576.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14092.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6910.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9884.55},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15244.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":14952.73},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11294.07},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":11294.07},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":14952.73},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6775.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":12845.47},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":17576.08},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6910.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6842.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6842.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14555.05},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":6775.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15202.2},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10950.26},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":15202.2},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6842.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7113.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7046.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6842.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":12605.44,"10th_percentile":8875.93,"90th_percentile":34992.0,"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":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"49","median_amount":315.54,"10th_percentile":293.62,"90th_percentile":6074.39,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":9893.42,"10th_percentile":9884.55,"90th_percentile":12437.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"23","median_amount":13531.89,"10th_percentile":9786.21,"90th_percentile":14231.89,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"24","median_amount":10755.66,"10th_percentile":7892.62,"90th_percentile":16763.0,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6659.84,"10th_percentile":6659.84,"90th_percentile":10755.66,"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":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"36","median_amount":408.3,"10th_percentile":293.62,"90th_percentile":5963.35,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"19","median_amount":11532.76,"10th_percentile":8386.21,"90th_percentile":22576.54,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14231.89,"10th_percentile":14231.89,"90th_percentile":14231.89,"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":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":21786.52,"10th_percentile":12100.03,"90th_percentile":26881.65},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"1 through 10","median_amount":16827.16,"10th_percentile":16827.16,"90th_percentile":16827.16},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_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":315.54,"10th_percentile":315.54,"90th_percentile":315.54,"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":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":5932.1,"10th_percentile":293.62,"90th_percentile":6019.49,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"53","median_amount":408.3,"10th_percentile":293.62,"90th_percentile":6095.83,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":17901.47,"10th_percentile":17901.47,"90th_percentile":17901.47},{"payer_name":"Molina","plan_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":160.99,"10th_percentile":160.99,"90th_percentile":160.99,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":4283.15,"10th_percentile":4283.15,"90th_percentile":4283.15,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"11","median_amount":3457.01,"10th_percentile":1880.73,"90th_percentile":4114.1,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"21","median_amount":14191.32,"10th_percentile":1024.53,"90th_percentile":15215.85,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4589.45,"10th_percentile":4589.45,"90th_percentile":4589.45,"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":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"72","median_amount":315.54,"10th_percentile":293.62,"90th_percentile":4911.04,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"22","median_amount":315.54,"10th_percentile":293.62,"90th_percentile":6010.19,"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":"Other Digestive System Diagnoses With Mcc","code_information":[{"code":"393","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13283.31,"maximum":36056.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27629.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13548.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":20277.52},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29887.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":30674.57},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23169.06},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":23169.06},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":30674.57},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13283.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":26351.67},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":36056.22},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13548.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13416.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13416.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29858.77},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":13283.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":31186.35},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22463.77},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":31186.35},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13416.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13947.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13814.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13416.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"14","median_amount":12318.37,"10th_percentile":623.13,"90th_percentile":12573.45,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30203.78,"10th_percentile":30203.78,"90th_percentile":30203.78,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22826.3,"10th_percentile":22826.3,"90th_percentile":22826.3,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29655.8,"10th_percentile":29655.8,"90th_percentile":29655.8,"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":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":10713.64,"10th_percentile":669.65,"90th_percentile":12160.04,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":12164.92,"10th_percentile":12164.92,"90th_percentile":12164.92,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"13","median_amount":669.65,"10th_percentile":623.13,"90th_percentile":12403.56,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":10841.28,"10th_percentile":623.13,"90th_percentile":19491.61,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":12271.43,"10th_percentile":623.13,"90th_percentile":12285.55,"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."}]}]},{"description":"Other Digestive System Diagnoses With Cc","code_information":[{"code":"394","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8014.5,"maximum":21095.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16670.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8174.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11863.74},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18032.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":17946.73},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13555.49},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":13555.49},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":17946.73},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8014.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":15417.53},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":21095.36},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8174.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8094.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8094.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17469.43},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":8014.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18246.15},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13142.84},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":18246.15},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8094.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8415.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8335.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8094.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"27","median_amount":490.05,"10th_percentile":354.2,"90th_percentile":7241.73,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11934.74,"10th_percentile":11934.74,"90th_percentile":11934.74,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"1 through 10","median_amount":25313.68,"10th_percentile":25313.68,"90th_percentile":25313.68},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":29603.01,"10th_percentile":29603.01,"90th_percentile":29603.01},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":17300.88,"10th_percentile":17200.22,"90th_percentile":17300.88,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17168.37,"10th_percentile":17168.37,"90th_percentile":17168.37,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12974.88,"10th_percentile":12974.88,"90th_percentile":56194.64,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5422.56,"10th_percentile":5422.56,"90th_percentile":5422.56,"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":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":380.64,"10th_percentile":380.64,"90th_percentile":6980.42,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12624.99,"10th_percentile":10409.69,"90th_percentile":14706.76,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"16","median_amount":490.05,"10th_percentile":354.2,"90th_percentile":7156.72,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":21241.91,"10th_percentile":21241.91,"90th_percentile":21241.91},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":3457.01,"10th_percentile":3445.52,"90th_percentile":10246.02,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17119.42,"10th_percentile":17119.42,"90th_percentile":17119.42,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11130.83,"10th_percentile":11130.83,"90th_percentile":11130.83,"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":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"20","median_amount":380.64,"10th_percentile":354.2,"90th_percentile":7175.4,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":354.2,"10th_percentile":354.2,"90th_percentile":7163.11,"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."}]}]},{"description":"Other Digestive System Diagnoses Without Cc/Mcc","code_information":[{"code":"395","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5738.18,"maximum":14631.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11935.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5852.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8228.67},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12910.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":12447.82},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9402.06},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":9402.06},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":12447.82},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5738.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":10693.57},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":14631.71},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5852.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5795.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5795.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12116.77},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":5738.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12655.5},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9115.85},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":12655.5},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5795.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6025.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5967.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5795.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":239.47,"10th_percentile":239.47,"90th_percentile":239.47,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":28153.44,"10th_percentile":28153.44,"90th_percentile":28153.44},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":12054.53,"10th_percentile":12054.53,"90th_percentile":12054.53,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6997.14,"10th_percentile":6997.14,"90th_percentile":6997.14,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":239.47,"10th_percentile":239.47,"90th_percentile":4616.27,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":12435.47,"10th_percentile":12435.47,"90th_percentile":12435.47},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":4973.17,"10th_percentile":4973.17,"90th_percentile":4973.17,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":339.89,"10th_percentile":339.89,"90th_percentile":339.89,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":2378.23,"10th_percentile":2378.23,"90th_percentile":2378.23,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12409.8,"10th_percentile":12409.8,"90th_percentile":12409.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":3196.7,"10th_percentile":257.35,"90th_percentile":4933.02,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"1 through 10","median_amount":4550.62,"10th_percentile":257.35,"90th_percentile":52483.06,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":19600.17,"maximum":53993.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40768.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19992.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":30364.94},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44100.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":45934.18},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34694.92},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":34694.92},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":45934.18},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19600.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":39460.77},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":53993.02},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19992.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19796.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19796.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":44712.54},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":19600.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":46700.55},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33638.77},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":46700.55},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19796.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20580.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20384.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19796.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34951.17,"10th_percentile":34951.17,"90th_percentile":34951.17,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":19006.69,"10th_percentile":19006.69,"90th_percentile":19006.69,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":12602.88,"maximum":34124.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26213.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12854.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19190.93},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28356.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":29030.85},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21927.52},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":21927.52},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":29030.85},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12602.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":24939.59},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":34124.11},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12854.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12728.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12728.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":28258.76},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":12602.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29515.2},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21260.03},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":29515.2},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12728.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13233.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13107.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12728.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":23673.06,"10th_percentile":23673.06,"90th_percentile":24627.06,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":569.4,"10th_percentile":569.4,"90th_percentile":11383.41,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19185.86,"10th_percentile":19185.86,"90th_percentile":19185.86,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":37121.65,"10th_percentile":24916.13,"90th_percentile":51823.63},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":27121.64,"10th_percentile":27121.64,"90th_percentile":29129.29,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23472.44,"10th_percentile":23472.44,"90th_percentile":23472.44,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19879.98,"10th_percentile":19879.98,"90th_percentile":19879.98,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":569.4,"10th_percentile":569.4,"90th_percentile":569.4,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22091.69,"10th_percentile":20722.44,"90th_percentile":22416.05,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":11158.63,"10th_percentile":11158.63,"90th_percentile":11158.63,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_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":7572.96,"10th_percentile":7572.96,"90th_percentile":7572.96,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":6598.2,"10th_percentile":6598.2,"90th_percentile":6598.2,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29507.4,"10th_percentile":29507.4,"90th_percentile":29507.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":11272.02,"10th_percentile":569.4,"90th_percentile":11272.19,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":11199.1,"10th_percentile":569.4,"90th_percentile":11281.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Appendix Procedures Without Cc/Mcc","code_information":[{"code":"399","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9673.91,"maximum":25807.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20121.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9867.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14513.65},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21766.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":21955.35},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16583.27},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":16583.27},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":21955.35},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9673.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":18861.22},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":25807.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9867.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9770.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9770.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21371.43},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":9673.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22321.65},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16078.46},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":22321.65},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9770.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10157.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10060.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9770.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":9165.76,"10th_percentile":9165.76,"90th_percentile":9165.76,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24052.21,"10th_percentile":24052.21,"90th_percentile":24052.21,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"1 through 10","median_amount":28497.53,"10th_percentile":28497.53,"90th_percentile":28497.53},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":20107.87,"10th_percentile":13471.65,"90th_percentile":43894.94},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":20321.33,"10th_percentile":20321.33,"90th_percentile":20321.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20496.99,"10th_percentile":20496.99,"90th_percentile":20496.99,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10472.71,"10th_percentile":10472.71,"90th_percentile":13225.46,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13140.46,"10th_percentile":13140.46,"90th_percentile":13140.46,"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":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":7602.57,"10th_percentile":7602.57,"90th_percentile":7602.57,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17017.81,"10th_percentile":13642.81,"90th_percentile":49987.0,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":37893.03,"10th_percentile":37205.35,"90th_percentile":60914.04},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":422.87,"10th_percentile":422.87,"90th_percentile":8440.7,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":28935.68,"10th_percentile":28935.68,"90th_percentile":28935.68},{"payer_name":"Molina","plan_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":3909.2,"10th_percentile":3909.2,"90th_percentile":3909.2,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":3584.25,"10th_percentile":3584.25,"90th_percentile":3584.25,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20438.55,"10th_percentile":20438.55,"90th_percentile":21074.55,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9251.09,"10th_percentile":9251.09,"90th_percentile":9251.09,"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":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":599.51,"10th_percentile":422.87,"90th_percentile":8789.63,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":32507.01,"maximum":90642.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":67614.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33157.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":50975.92},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":73140.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":77113.19},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":58244.98},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":58244.98},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":77113.19},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32507.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":66245.78},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":90642.17},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33157.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32832.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32832.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":75062.33},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":32507.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":78399.75},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":56471.94},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":78399.75},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32832.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34132.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33807.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32832.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":60492.99,"10th_percentile":60492.99,"90th_percentile":60492.99,"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":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":28637.41,"10th_percentile":1472.11,"90th_percentile":31333.83,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":77888.99,"10th_percentile":77888.99,"90th_percentile":77888.99},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":81168.4,"10th_percentile":81168.4,"90th_percentile":81168.4,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":58675.18,"10th_percentile":58675.18,"90th_percentile":71354.62,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":28316.96,"10th_percentile":28316.96,"90th_percentile":28316.96,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":60731.56,"10th_percentile":60731.56,"90th_percentile":61331.56,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"1 through 10","median_amount":49151.2,"10th_percentile":49151.2,"90th_percentile":49151.2},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"12","median_amount":28123.38,"10th_percentile":1472.11,"90th_percentile":29388.16,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":27285.17,"10th_percentile":1472.11,"90th_percentile":30428.64,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"1 through 10","median_amount":27639.37,"10th_percentile":27639.37,"90th_percentile":27639.37,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":6336.79,"10th_percentile":6336.79,"90th_percentile":6336.79,"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."}]}]},{"description":"Pancreas, Liver And Shunt Procedures With Mcc","code_information":[{"code":"405","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":44019.63,"maximum":123332.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":91560.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44900.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":69360.47},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":99044.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":23677.01,"10th_percentile":23677.01,"90th_percentile":23677.01,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":23612.12,"maximum":65385.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":49113.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24084.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":36771.64},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":53127.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":55625.84},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42015.2},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":42015.2},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":55625.84},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23612.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":47786.6},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":65385.01},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24084.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23848.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23848.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":54146.44},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":23612.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":56553.9},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40736.21},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":56553.9},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23848.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24792.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24556.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23848.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":42227.76,"10th_percentile":42227.76,"90th_percentile":42227.76,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":51076.37,"10th_percentile":51076.37,"90th_percentile":51076.37,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":18208.33,"maximum":50040.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37873.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18572.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":28142.31},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40968.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":42571.93},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32155.35},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":32155.35},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":42571.93},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18208.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":36572.35},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":50040.88},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18572.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18390.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18390.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":41439.71},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":18208.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":43282.2},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31176.5},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":43282.2},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18390.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19118.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18936.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18390.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":28895.22,"maximum":80386.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":60102.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29473.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":45208.24},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":65014.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":68388.21},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":51654.85},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":51654.85},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":68388.21},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28895.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":58750.39},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":80386.45},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29473.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29184.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29184.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":17872.48,"maximum":49087.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37174.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18229.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":27605.99},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40213.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":41760.61},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31542.55},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":31542.55},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":41760.61},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17872.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":35875.37},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":49087.23},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18229.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18051.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18051.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":13191.21,"maximum":35794.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27437.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13455.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":20130.45},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29680.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":30452.09},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23001.01},{"payer_name":"Blue Cross","plan_name":"Health Options - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - 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With Mcc","code_information":[{"code":"411","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26812.63,"maximum":74472.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":55770.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27348.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":41882.54},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":60328.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":63357.29},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":47854.91},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":47854.91},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":63357.29},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26812.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":54428.47},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":74472.9},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27348.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27080.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27080.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":61672.28},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":26812.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":64414.35},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":46398.15},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":64414.35},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27080.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28153.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27885.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27080.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - 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With Cc","code_information":[{"code":"412","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17278.59,"maximum":47400.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35939.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17624.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":26657.6},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38876.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":40325.95},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30458.92},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":30458.92},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":40325.95},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17278.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":34642.89},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":47400.86},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17624.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17451.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17451.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":39253.46},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":17278.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":40998.75},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29531.72},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":40998.75},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17451.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18142.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17969.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17451.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":861.97,"10th_percentile":861.97,"90th_percentile":861.97,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":14035.04,"10th_percentile":14035.04,"90th_percentile":14035.04,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":13769.23,"maximum":37435.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28640.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14044.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":21053.48},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30980.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":31848.39},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24055.66},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":24055.66},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":31848.39},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13769.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":27360.06},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":37435.97},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14044.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13906.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13906.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":31001.37},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":13769.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":32379.75},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23323.38},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":32379.75},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13906.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14457.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14320.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13906.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":12343.02,"10th_percentile":12343.02,"90th_percentile":12343.02,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16915.9,"10th_percentile":16915.9,"90th_percentile":16915.9,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":28871.4,"maximum":80318.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":60052.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29448.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":45170.21},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":64960.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":68330.67},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":51611.39},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":51611.39},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":68330.67},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28871.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":58700.96},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":80318.82},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29448.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29160.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29160.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":66513.39},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":28871.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":69470.7},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":50040.28},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":69470.7},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29160.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30314.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30026.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29160.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":46521.38,"10th_percentile":46521.38,"90th_percentile":46521.38,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":16994.35,"maximum":46593.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35348.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17334.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":26203.69},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38237.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":39639.31},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29940.28},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":29940.28},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":39639.31},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16994.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":34053.02},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":46593.75},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17334.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17164.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17164.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":11409.54,"maximum":30735.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23731.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11637.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17285.28},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25671.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":26148.09},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19750.13},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":19750.13},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":26148.09},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11409.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":22463.09},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":30735.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11637.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11523.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11523.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - 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Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":19532.68,"maximum":53801.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40627.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19923.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":30257.17},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43948.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":45771.15},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34571.78},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":34571.78},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":45771.15},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19532.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":39320.71},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":53801.39},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19923.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19728.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19728.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":44553.85},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":19532.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":46534.8},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33519.37},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":46534.8},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19728.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20509.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20313.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19728.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":961.01,"10th_percentile":961.01,"90th_percentile":19364.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":43752.65,"10th_percentile":43752.65,"90th_percentile":43752.65,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32535.9,"10th_percentile":29916.17,"90th_percentile":33037.12,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":961.01,"10th_percentile":961.01,"90th_percentile":16863.97,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36656.39,"10th_percentile":36656.39,"90th_percentile":66262.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":38744.15,"10th_percentile":38744.15,"90th_percentile":38744.15},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":5237.79,"10th_percentile":5237.79,"90th_percentile":5237.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"16","median_amount":885.93,"10th_percentile":624.03,"90th_percentile":13397.2,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21026.85,"10th_percentile":21026.85,"90th_percentile":21026.85,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":44060.09,"10th_percentile":44060.09,"90th_percentile":44060.09},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":32119.81,"10th_percentile":29725.56,"90th_percentile":32119.81,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30247.56,"10th_percentile":30247.56,"90th_percentile":30247.56,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22359.39,"10th_percentile":19309.39,"90th_percentile":80276.15,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14956.08,"10th_percentile":14956.08,"90th_percentile":14956.08,"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":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"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":885.93,"10th_percentile":624.03,"90th_percentile":12236.0,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25398.74,"10th_percentile":25398.74,"90th_percentile":25998.74,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":52905.81,"10th_percentile":52905.81,"90th_percentile":54541.96},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"1 through 10","median_amount":36769.56,"10th_percentile":36769.56,"90th_percentile":36769.56},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_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":624.03,"10th_percentile":624.03,"90th_percentile":624.03,"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":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"15","median_amount":885.93,"10th_percentile":624.03,"90th_percentile":13106.97,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":25195.58,"10th_percentile":25195.58,"90th_percentile":25195.58},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":5237.79,"10th_percentile":5237.79,"90th_percentile":5622.09,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30161.32,"10th_percentile":2597.0,"90th_percentile":32986.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19369.66,"10th_percentile":19369.66,"90th_percentile":22506.15,"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":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"13","median_amount":624.03,"10th_percentile":624.03,"90th_percentile":12322.73,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":12308.39,"10th_percentile":624.03,"90th_percentile":12316.79,"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."}]}]},{"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":11429.39,"maximum":30791.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23773.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11657.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17316.98},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25716.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":26196.04},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19786.34},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":19786.34},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":26196.04},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11429.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":22504.29},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":30791.96},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11657.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11543.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11543.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25499.35},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":11429.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26633.1},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19184.03},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":26633.1},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11543.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12000.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11886.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11543.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":21356.69,"10th_percentile":21356.69,"90th_percentile":21356.69,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":9959.31,"10th_percentile":495.79,"90th_percentile":11423.13,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1446.48,"10th_percentile":1446.48,"90th_percentile":1446.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20260.48,"10th_percentile":20260.48,"90th_percentile":28248.03,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15512.41,"10th_percentile":12161.8,"90th_percentile":15516.45,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11125.88,"10th_percentile":11125.88,"90th_percentile":11125.88,"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":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":8211.2,"10th_percentile":8211.2,"90th_percentile":8211.2,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18231.72,"10th_percentile":15621.57,"90th_percentile":97399.0,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22045.68,"10th_percentile":22045.68,"90th_percentile":22045.68,"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":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"11","median_amount":532.81,"10th_percentile":495.79,"90th_percentile":9843.96,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_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":7961.45,"10th_percentile":7961.45,"90th_percentile":7961.45,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":4307.85,"10th_percentile":4307.85,"90th_percentile":4307.85,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":4543.31,"10th_percentile":4543.31,"90th_percentile":4543.31,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23963.19,"10th_percentile":23963.19,"90th_percentile":23963.19,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"12","median_amount":532.81,"10th_percentile":495.79,"90th_percentile":9870.03,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":27636.77,"maximum":76813.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":57484.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28189.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":43198.62},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62182.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":24403.11,"10th_percentile":24403.11,"90th_percentile":24403.11,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":14380.59,"maximum":39171.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29911.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14668.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22029.76},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32356.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":33325.25},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25171.16},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":25171.16},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":33325.25},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14380.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":28628.79},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":39171.94},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14668.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14524.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14524.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":32438.95},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":14380.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":33881.25},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24404.93},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":33881.25},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14524.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15099.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14955.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14524.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22223.87,"10th_percentile":22223.87,"90th_percentile":22223.87,"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":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":11696.95,"maximum":31551.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24329.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11930.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17744.26},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26318.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":26842.41},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20274.56},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":20274.56},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":26842.41},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11696.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":23059.56},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":31551.73},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11930.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11813.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11813.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26128.53},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":11696.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":27290.25},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19657.38},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":27290.25},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11813.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12281.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12164.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11813.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":33559.03,"maximum":93629.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":69802.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34230.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":52655.89},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":75507.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":79654.54},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":60164.51},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":60164.51},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":79654.54},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33559.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":68428.98},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":93629.39},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34230.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33894.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33894.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":77536.09},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":33559.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":80983.5},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":58333.04},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":80983.5},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33894.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35236.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34901.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33894.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":31716.07,"10th_percentile":31716.07,"90th_percentile":31716.07,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":31405.13,"10th_percentile":31405.13,"90th_percentile":31405.13,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36586.12,"10th_percentile":36586.12,"90th_percentile":36586.12,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29255.02,"10th_percentile":29255.02,"90th_percentile":29255.02,"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":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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 Or Custom-Made","code_information":[{"code":"426","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":88090.74,"maximum":248472.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":183228.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":89852.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":139737.79},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":198204.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":211386.62},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":159664.12},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":159664.12},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":211386.62},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":88090.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":181596.31},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":248472.95},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":89852.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":88971.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":88971.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":205764.7},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":88090.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":214913.4},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":154803.78},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":214913.4},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":88971.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":92495.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":91614.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":88971.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":184084.73,"10th_percentile":184084.73,"90th_percentile":184084.73,"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":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":45550.41,"10th_percentile":4236.02,"90th_percentile":85470.44,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":69308.95,"10th_percentile":69308.95,"90th_percentile":69308.95,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":62792.05,"10th_percentile":5772.03,"90th_percentile":82405.59,"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."}]}]},{"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":57899.09,"maximum":162743.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":120430.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59057.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":91524.63},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":130272.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":138452.75},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":104575.86},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":104575.86},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":138452.75},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57899.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":118940.87},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":162743.34},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59057.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58478.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58478.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":134770.54},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":57899.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":140762.7},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":101392.46},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":140762.7},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58478.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60794.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60215.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58478.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":113812.98,"10th_percentile":113812.98,"90th_percentile":113812.98,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":51405.28,"10th_percentile":51376.28,"90th_percentile":54730.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":129176.8,"10th_percentile":129176.8,"90th_percentile":129176.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":51431.97,"10th_percentile":51431.97,"90th_percentile":51431.97,"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."}]}]},{"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":45222.5,"maximum":126747.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":94062.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46126.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":71281.34},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":101750.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":107829.96},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":81445.91},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":81445.91},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":107829.96},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45222.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":92633.69},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":126747.99},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46126.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45674.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45674.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":104962.18},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":45222.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":109629.0},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":78966.61},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":109629.0},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45674.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47483.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47031.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45674.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":5636.0,"10th_percentile":5636.0,"90th_percentile":5636.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":39590.14,"10th_percentile":2071.11,"90th_percentile":40780.92,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":85937.78,"10th_percentile":85937.78,"90th_percentile":85937.78,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":77600.61,"10th_percentile":77600.61,"90th_percentile":90656.44},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":3787.84,"10th_percentile":2944.36,"90th_percentile":42166.95,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":101375.07,"10th_percentile":101375.07,"90th_percentile":101375.07,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":40230.88,"10th_percentile":2071.11,"90th_percentile":40866.88,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":72119.16,"maximum":203121.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":150007.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":73561.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":114232.72},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":162268.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":15360.73,"10th_percentile":15360.73,"90th_percentile":15360.73,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":139363.41,"10th_percentile":139363.41,"90th_percentile":139363.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38701.14,"10th_percentile":38701.14,"90th_percentile":42001.14,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26504.23,"10th_percentile":19275.25,"90th_percentile":27004.23,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28323.91,"10th_percentile":28323.91,"90th_percentile":28323.91,"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":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":138386.42,"10th_percentile":30497.68,"90th_percentile":138386.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"11","median_amount":1030.78,"10th_percentile":737.18,"90th_percentile":15162.66,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":9330.68,"10th_percentile":9330.68,"90th_percentile":9330.68,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38202.45,"10th_percentile":38202.45,"90th_percentile":38202.45,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":236317.52,"10th_percentile":236317.52,"90th_percentile":236317.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"15","median_amount":1030.78,"10th_percentile":737.18,"90th_percentile":14756.78,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":8971.24,"maximum":23812.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18660.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9150.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13391.56},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20185.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":553.15,"10th_percentile":432.6,"90th_percentile":8105.84,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13391.56,"10th_percentile":13391.56,"90th_percentile":13391.56,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":19937.21,"10th_percentile":19393.38,"90th_percentile":20861.66,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21752.32,"10th_percentile":21752.32,"90th_percentile":21752.32,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14746.12,"10th_percentile":14746.12,"90th_percentile":14746.12,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11081.47,"10th_percentile":11081.47,"90th_percentile":11531.86,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"1 through 10","median_amount":19471.09,"10th_percentile":19471.09,"90th_percentile":19471.09},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":553.15,"10th_percentile":402.55,"90th_percentile":968.7,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":22063.07,"10th_percentile":22063.07,"90th_percentile":22063.07},{"payer_name":"Molina","plan_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":2668.32,"10th_percentile":2668.32,"90th_percentile":2668.32,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":3158.0,"10th_percentile":3158.0,"90th_percentile":3158.0,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20595.9,"10th_percentile":20595.9,"90th_percentile":20595.9,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14518.26,"10th_percentile":14518.26,"90th_percentile":14518.26,"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":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":553.15,"10th_percentile":402.55,"90th_percentile":8535.42,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1748.6,"10th_percentile":1748.6,"90th_percentile":8034.01,"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."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc","code_information":[{"code":"434","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6242.35,"maximum":16063.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12984.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6367.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9033.79},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14045.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":19097.99,"10th_percentile":19097.99,"90th_percentile":19097.99},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":15168.21,"maximum":41408.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31549.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15471.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":23287.52},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34128.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":35227.91},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26608.27},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":26608.27},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":35227.91},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15168.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":30263.31},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":41408.4},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15471.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15319.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15319.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":760.0,"10th_percentile":686.57,"90th_percentile":13495.4,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":20359.31,"10th_percentile":20359.31,"90th_percentile":20359.31},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13284.79,"10th_percentile":13284.79,"90th_percentile":13284.79,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":12456.91,"10th_percentile":12456.91,"90th_percentile":12456.91,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":13495.99,"10th_percentile":13495.99,"90th_percentile":13495.99,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":13471.14,"10th_percentile":686.57,"90th_percentile":17600.85,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33184.0,"10th_percentile":33184.0,"90th_percentile":33184.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":13363.09,"10th_percentile":737.83,"90th_percentile":13522.86,"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."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas With Cc","code_information":[{"code":"436","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9565.93,"maximum":25500.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19897.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9757.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14341.22},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21523.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":21694.5},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16386.25},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":16386.25},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":21694.5},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9565.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":18637.13},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":25500.65},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9757.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9661.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9661.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21117.52},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":9565.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22056.45},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15887.43},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":22056.45},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9661.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10044.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9948.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9661.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":17846.71,"10th_percentile":17846.71,"90th_percentile":17846.71,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":456.01,"10th_percentile":456.01,"90th_percentile":8580.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8361.21,"10th_percentile":8361.21,"90th_percentile":8361.21,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12544.22,"10th_percentile":12544.22,"90th_percentile":12544.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17678.95,"10th_percentile":17678.95,"90th_percentile":17678.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":8464.49,"10th_percentile":424.34,"90th_percentile":9118.62,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1480.67,"10th_percentile":1480.67,"90th_percentile":1480.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"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":7360.27,"maximum":19237.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15309.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7507.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10818.99},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16560.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":30034.15,"10th_percentile":30034.15,"90th_percentile":30034.15,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27213.42,"10th_percentile":27213.42,"90th_percentile":27213.42,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23791.14,"10th_percentile":23791.14,"90th_percentile":23791.14,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":5909.62,"10th_percentile":5909.62,"90th_percentile":5909.62,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26081.82,"10th_percentile":26081.82,"90th_percentile":26081.82,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":12693.54,"10th_percentile":12693.54,"90th_percentile":12693.54,"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."}]}]},{"description":"Disorders Of Pancreas Except Malignancy With Cc","code_information":[{"code":"439","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7264.2,"maximum":18964.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15109.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7409.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10665.57},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16344.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":16134.22},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12186.46},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":12186.46},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":16134.22},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7264.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":13860.45},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":18964.85},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7409.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7336.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7336.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15705.12},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":7264.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16403.4},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11815.5},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":16403.4},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7336.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7627.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7554.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7336.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":13810.91,"10th_percentile":13810.91,"90th_percentile":13810.91,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"12","median_amount":4939.56,"10th_percentile":323.68,"90th_percentile":7287.6,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10906.48,"10th_percentile":10906.48,"90th_percentile":10906.48,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":16862.06,"10th_percentile":16124.2,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13485.36,"10th_percentile":6743.48,"90th_percentile":16253.67,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4590.23,"10th_percentile":4590.23,"90th_percentile":4590.23,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":10288.47,"10th_percentile":6918.47,"90th_percentile":13963.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":2630.58,"10th_percentile":2630.58,"90th_percentile":2630.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":6839.08,"10th_percentile":6839.08,"90th_percentile":6839.08,"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."}]}]},{"description":"Disorders Of Pancreas Except Malignancy Without Cc/Mcc","code_information":[{"code":"440","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5519.04,"maximum":14009.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11479.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5629.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":7878.73},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12417.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":11918.45},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9002.22},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":9002.22},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":11918.45},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5519.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":10238.81},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":14009.46},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5629.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5574.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5574.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11601.48},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":5519.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12117.3},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8728.18},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":12117.3},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5574.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5794.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5739.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5574.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":11809.97,"10th_percentile":11809.97,"90th_percentile":11809.97,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":1216.0,"10th_percentile":1216.0,"90th_percentile":5183.59,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"1 through 10","median_amount":19023.02,"10th_percentile":19023.02,"90th_percentile":19023.02},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":30147.63,"10th_percentile":30147.63,"90th_percentile":30147.63},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":11518.27,"10th_percentile":11518.27,"90th_percentile":11518.27,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26180.0,"10th_percentile":26180.0,"90th_percentile":42114.0,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":4304.25,"10th_percentile":4304.25,"90th_percentile":4304.25,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9642.92,"10th_percentile":9642.92,"90th_percentile":10314.62,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":17340.68,"10th_percentile":17340.68,"90th_percentile":17340.68},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":4806.35,"10th_percentile":4806.35,"90th_percentile":4806.35,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":2630.58,"10th_percentile":2630.58,"90th_percentile":2630.58,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11186.82,"10th_percentile":11186.82,"90th_percentile":11822.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":280.72,"10th_percentile":231.46,"90th_percentile":5513.45,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":4820.25,"10th_percentile":4820.25,"90th_percentile":4820.25,"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."}]}]},{"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":14834.74,"maximum":40461.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30856.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15131.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22755.0},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33378.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34479.01,"10th_percentile":34479.01,"90th_percentile":34479.01,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26057.27,"10th_percentile":26057.27,"90th_percentile":26057.27,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":32861.81,"10th_percentile":32861.81,"90th_percentile":32861.81},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1479.0,"10th_percentile":711.33,"90th_percentile":14112.98,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"1 through 10","median_amount":13011.32,"10th_percentile":13011.32,"90th_percentile":13011.32,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":8249.52,"maximum":21762.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17159.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8414.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12239.04},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18561.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":18514.45},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13984.3},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":13984.3},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":18514.45},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8249.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":15905.25},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":21762.69},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8414.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8332.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8332.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":18395.48,"10th_percentile":18395.48,"90th_percentile":18395.48},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":17830.67,"10th_percentile":17830.67,"90th_percentile":17830.67,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17447.52,"10th_percentile":17447.52,"90th_percentile":17447.52,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13318.1,"10th_percentile":13318.1,"90th_percentile":13318.1,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11900.9,"10th_percentile":11900.9,"90th_percentile":11900.9,"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":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":7220.21,"10th_percentile":7220.21,"90th_percentile":7220.21,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11418.41,"10th_percentile":11418.41,"90th_percentile":11418.41,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":7262.77,"10th_percentile":7262.77,"90th_percentile":7262.77,"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."}]}]},{"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":6140.73,"maximum":15774.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12772.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6263.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8871.5},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13816.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12780.0,"10th_percentile":12780.0,"90th_percentile":12780.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":13851.8,"maximum":37670.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28811.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14128.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":21185.34},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31166.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":32047.86},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24206.33},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":24206.33},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":32047.86},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13851.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":27531.42},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":37670.44},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14128.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13990.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13990.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":3012.0,"10th_percentile":633.81,"90th_percentile":12618.57,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21356.51,"10th_percentile":21356.51,"90th_percentile":21356.51,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":57687.29,"10th_percentile":57687.29,"90th_percentile":57687.29},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":1070.04,"10th_percentile":1070.04,"90th_percentile":1070.04,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24385.11,"10th_percentile":24385.11,"90th_percentile":24385.11,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":11000.3,"10th_percentile":681.14,"90th_percentile":12905.56,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27435.27,"10th_percentile":27435.27,"90th_percentile":27435.27,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":5748.2,"10th_percentile":5748.2,"90th_percentile":5748.2,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":4856.4,"10th_percentile":4856.4,"90th_percentile":4856.4,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1750.0,"10th_percentile":633.81,"90th_percentile":12524.45,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":681.14,"10th_percentile":681.14,"90th_percentile":12494.86,"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."}]}]},{"description":"Disorders Of The Biliary Tract With Cc","code_information":[{"code":"445","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9274.54,"maximum":24673.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19291.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9460.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13875.9},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20867.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":20990.59},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15854.57},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":15854.57},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":20990.59},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9274.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":18032.43},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":24673.25},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9460.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9367.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9367.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20432.34},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":9274.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21340.8},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15371.94},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":21340.8},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9367.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9738.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9645.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9367.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"11","median_amount":438.55,"10th_percentile":382.12,"90th_percentile":8272.53,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":41486.06,"10th_percentile":41486.06,"90th_percentile":41486.06,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":39268.94,"10th_percentile":39268.94,"90th_percentile":39268.94},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":19762.7,"10th_percentile":19762.7,"90th_percentile":19762.7,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14948.75,"10th_percentile":14948.75,"90th_percentile":14948.75,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":7884.53,"10th_percentile":573.16,"90th_percentile":8251.54,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14570.36,"10th_percentile":14570.36,"90th_percentile":16751.71,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"1 through 10","median_amount":3739.82,"10th_percentile":3739.82,"90th_percentile":3739.82,"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":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"15","median_amount":438.55,"10th_percentile":408.08,"90th_percentile":8191.22,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":3637.02,"10th_percentile":3637.02,"90th_percentile":3637.02,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":8103.49,"10th_percentile":573.16,"90th_percentile":8730.94,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"1 through 10","median_amount":408.08,"10th_percentile":408.08,"90th_percentile":408.08,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":573.16,"10th_percentile":438.55,"90th_percentile":8204.88,"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."}]}]},{"description":"Disorders Of The Biliary Tract Without Cc/Mcc","code_information":[{"code":"446","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7153.84,"maximum":18651.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14879.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7296.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10489.34},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16096.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":15867.61},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11985.1},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":11985.1},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":15867.61},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7153.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":13631.42},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":18651.48},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7296.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7225.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7225.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15445.61},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":7153.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16132.35},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11620.26},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":16132.35},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7225.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7511.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7439.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7225.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2410.8,"10th_percentile":2410.8,"90th_percentile":2410.8,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":29977.77,"10th_percentile":29977.77,"90th_percentile":29977.77},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10989.98,"10th_percentile":10989.98,"90th_percentile":10989.98,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17093.31,"10th_percentile":17093.31,"90th_percentile":17093.31,"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":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":5478.58,"10th_percentile":5478.58,"90th_percentile":5478.58,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":6503.02,"10th_percentile":6503.02,"90th_percentile":6503.02,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":35624.51,"10th_percentile":35624.51,"90th_percentile":35624.51},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":6441.09,"10th_percentile":6441.09,"90th_percentile":6441.09,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":6069.46,"10th_percentile":6069.46,"90th_percentile":6069.46,"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."}]}]},{"description":"Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody","code_information":[{"code":"447","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":53635.45,"maximum":150636.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":111561.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54708.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":84716.01},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":120679.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":124744.8},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":53635.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":130291.2},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":93849.75},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":130291.2},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54171.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56317.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55780.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54171.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":2049.84,"10th_percentile":2049.84,"90th_percentile":41170.16,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_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":1734.48,"10th_percentile":1734.48,"90th_percentile":1734.48,"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":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":2522.88,"10th_percentile":1892.16,"90th_percentile":37369.42,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":34256.13,"maximum":95608.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":71252.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34941.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":53769.1},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":77076.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":81338.54},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":61436.47},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":61436.47},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":81338.54},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34256.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":69875.66},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":95608.84},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34941.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34598.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34598.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":79175.31},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":34256.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":82695.6},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":59566.28},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":82695.6},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34598.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35968.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35626.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34598.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":1650.0,"10th_percentile":1536.56,"90th_percentile":30040.9,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":79654.87,"10th_percentile":79654.87,"90th_percentile":79654.87,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":56286.96,"10th_percentile":56286.96,"90th_percentile":56286.96,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":25384.25,"10th_percentile":2220.99,"90th_percentile":31468.98,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":64981.37,"10th_percentile":64981.37,"90th_percentile":64981.37,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":25763.49,"10th_percentile":1488.62,"90th_percentile":29347.94,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":52463.88,"10th_percentile":52463.88,"90th_percentile":52463.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1536.56,"10th_percentile":350.0,"90th_percentile":24188.41,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1651.28,"10th_percentile":1248.45,"90th_percentile":29465.26,"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."}]}]},{"description":"Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F","code_information":[{"code":"450","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42900.92,"maximum":120155.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":89233.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43758.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":67574.0},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":96527.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":70988.98,"10th_percentile":70988.98,"90th_percentile":70988.98,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":16498.15,"10th_percentile":16498.15,"90th_percentile":16498.15,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":37408.91,"10th_percentile":1937.91,"90th_percentile":40189.42,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":26233.82,"maximum":72829.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":54566.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26758.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":40958.24},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":59026.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":61959.07},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":46798.8},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":46798.8},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":61959.07},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26233.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":53227.3},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":72829.37},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26758.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26496.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26496.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":22393.84,"10th_percentile":1161.21,"90th_percentile":25001.46,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":46919.56,"10th_percentile":46919.56,"90th_percentile":46919.56,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"1 through 10","median_amount":107005.06,"10th_percentile":107005.06,"90th_percentile":107005.06},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":57331.77,"10th_percentile":31272.04,"90th_percentile":66739.11},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":56148.6,"10th_percentile":56148.6,"90th_percentile":56148.6,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":47144.46,"10th_percentile":47144.46,"90th_percentile":47144.46,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":21919.39,"10th_percentile":1247.91,"90th_percentile":22147.65,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"1 through 10","median_amount":41373.99,"10th_percentile":41373.99,"90th_percentile":41373.99},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"24","median_amount":1691.82,"10th_percentile":1161.21,"90th_percentile":22811.46,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":60177.0,"10th_percentile":60177.0,"90th_percentile":60177.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"13","median_amount":1691.82,"10th_percentile":1161.21,"90th_percentile":23202.19,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":2401.0,"10th_percentile":1247.91,"90th_percentile":24586.55,"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."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"456","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":67306.09,"maximum":189454.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":139996.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68652.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":106546.71},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":151438.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":161177.21},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":121740.06},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":121740.06},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":161177.21},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67306.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":138462.82},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":189454.65},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68652.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67979.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67979.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":61068.38,"10th_percentile":61068.38,"90th_percentile":61068.38,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":60604.81,"10th_percentile":60604.81,"90th_percentile":60604.81,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":63002.89,"10th_percentile":63002.89,"90th_percentile":63002.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"457","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":47930.75,"maximum":134438.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":99695.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48889.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":75606.14},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":107844.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":168452.71,"10th_percentile":168452.71,"90th_percentile":168452.71,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"1 through 10","median_amount":19.65,"10th_percentile":19.65,"90th_percentile":19.65},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":41113.18,"10th_percentile":41113.18,"90th_percentile":41113.18,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":2159.66,"10th_percentile":1987.13,"90th_percentile":42916.2,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":41644.06,"10th_percentile":3123.0,"90th_percentile":44851.85,"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":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"458","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33714.64,"maximum":94071.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":70126.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34388.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":52904.4},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":75857.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":59519.31,"10th_percentile":59519.31,"90th_percentile":59519.31,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":69130.67,"10th_percentile":69130.67,"90th_percentile":69130.67,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":30994.27,"10th_percentile":1746.11,"90th_percentile":39513.03,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":78531.47,"10th_percentile":78531.47,"90th_percentile":78531.47,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":31096.77,"10th_percentile":31096.77,"90th_percentile":31096.77,"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."}]}]},{"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":44436.47,"maximum":124516.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":92427.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45325.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":70026.12},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":99982.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":105931.14},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":80011.7},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":80011.7},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":105931.14},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44436.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":91002.47},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":124516.04},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45325.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44880.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44880.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":103113.86},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":44436.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":107698.5},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":77576.06},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":107698.5},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44880.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46658.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46213.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44880.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":21705.0,"maximum":59969.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45146.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22139.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":33726.14},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48836.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"1 through 10","median_amount":47788.49,"10th_percentile":47788.49,"90th_percentile":47788.49},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":49933.04,"10th_percentile":49933.04,"90th_percentile":49933.04,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":51663.91,"10th_percentile":51663.91,"90th_percentile":52232.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":37302.49,"10th_percentile":37302.49,"90th_percentile":37302.49,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":1393.1,"10th_percentile":1077.61,"90th_percentile":20834.11,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":52232.85,"10th_percentile":52232.85,"90th_percentile":52232.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":23170.93,"10th_percentile":23170.93,"90th_percentile":23170.93,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":52083.93,"10th_percentile":52083.93,"90th_percentile":52083.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":21592.92,"10th_percentile":21592.92,"90th_percentile":21592.92,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"463","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":45837.83,"maximum":128495.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":95342.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46754.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":72263.96},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":103135.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_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":2984.94,"10th_percentile":2984.94,"90th_percentile":2984.94,"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":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":39057.65,"10th_percentile":39057.65,"90th_percentile":39057.65,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":44685.87,"10th_percentile":44685.87,"90th_percentile":44685.87,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"464","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25315.19,"maximum":70220.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52655.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25821.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":39491.28},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":56959.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":45912.47,"10th_percentile":45912.47,"90th_percentile":45912.47,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":9621.09,"10th_percentile":9621.09,"90th_percentile":9621.09,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":63436.65,"10th_percentile":63436.65,"90th_percentile":63436.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":17231.58,"10th_percentile":17231.58,"90th_percentile":20425.83,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":21399.94,"10th_percentile":21399.94,"90th_percentile":21399.94,"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."}]}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"465","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15064.99,"maximum":41115.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31335.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15366.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":23122.69},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33896.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":12110.31,"10th_percentile":12110.31,"90th_percentile":12110.31,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":2939.31,"10th_percentile":2939.31,"90th_percentile":2939.31,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":41914.81,"maximum":117355.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":87182.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42753.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":65999.27},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":94308.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":99839.57},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":75410.63},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":75410.63},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":99839.57},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41914.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":85769.38},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":117355.74},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42753.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42333.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42333.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":97184.3},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":41914.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":101505.3},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":73115.05},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":101505.3},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42333.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44010.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43591.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42333.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":39604.87,"10th_percentile":2726.17,"90th_percentile":39914.55,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":1917.03,"10th_percentile":1917.03,"90th_percentile":36772.53,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":36538.1,"10th_percentile":2060.15,"90th_percentile":39987.1,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":2100.0,"10th_percentile":1889.99,"90th_percentile":36499.15,"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."}]}]},{"description":"Revision Of Hip Or Knee Replacement With Cc","code_information":[{"code":"467","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28585.57,"maximum":79507.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":59457.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29157.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":44713.76},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":64317.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":67640.19},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":51089.85},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":51089.85},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":67640.19},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28585.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":58107.79},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":79507.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29157.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28871.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28871.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":65841.27},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":28585.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":68768.7},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":49534.62},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":68768.7},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28871.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30014.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29728.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28871.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"16","median_amount":16789.51,"10th_percentile":1191.65,"90th_percentile":27043.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":58538.03,"10th_percentile":58538.03,"90th_percentile":58538.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"15","median_amount":1846.96,"10th_percentile":1288.86,"90th_percentile":26532.53,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":79125.52,"10th_percentile":79125.52,"90th_percentile":79125.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":45264.32,"10th_percentile":45264.32,"90th_percentile":45264.32,"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":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"17","median_amount":1846.96,"10th_percentile":1288.86,"90th_percentile":26895.48,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"1 through 10","median_amount":25215.17,"10th_percentile":25215.17,"90th_percentile":25215.17,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1846.96,"10th_percentile":1288.86,"90th_percentile":26734.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Revision Of Hip Or Knee Replacement Without Cc/Mcc","code_information":[{"code":"468","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22403.69,"maximum":61953.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":46599.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22851.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":34841.89},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":50408.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"1 through 10","median_amount":39339.9,"10th_percentile":39339.9,"90th_percentile":49496.8},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":51781.61,"10th_percentile":51781.61,"90th_percentile":51781.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":47846.37,"10th_percentile":47846.37,"90th_percentile":47846.37,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33967.48,"10th_percentile":33967.48,"90th_percentile":33967.48,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":18276.15,"10th_percentile":987.1,"90th_percentile":20436.56,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":45014.05,"10th_percentile":45014.05,"90th_percentile":45014.05,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":68544.3,"10th_percentile":68544.3,"90th_percentile":68544.3},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"1 through 10","median_amount":45002.35,"10th_percentile":45002.35,"90th_percentile":45002.35},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"18","median_amount":1439.19,"10th_percentile":987.1,"90th_percentile":21201.86,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":48027.96,"10th_percentile":48027.96,"90th_percentile":48027.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":18042.72,"10th_percentile":987.1,"90th_percentile":20984.36,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"1 through 10","median_amount":19606.93,"10th_percentile":1439.19,"90th_percentile":21599.52,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":19213.5,"10th_percentile":1060.8,"90th_percentile":19242.2,"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."}]}]},{"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":24668.11,"maximum":68383.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":51309.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25161.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":38457.94},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":55503.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":43210.02,"10th_percentile":43210.02,"90th_percentile":43210.02,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":23724.05,"10th_percentile":23724.05,"90th_percentile":23724.05,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":11121.19,"10th_percentile":1229.96,"90th_percentile":23843.28,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":12507.45,"10th_percentile":1229.96,"90th_percentile":24499.9,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"1 through 10","median_amount":1229.96,"10th_percentile":1229.96,"90th_percentile":1229.96,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1321.79,"10th_percentile":1170.0,"90th_percentile":23906.0,"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":"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":15900.25,"maximum":43487.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33072.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16218.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":24456.52},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35775.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":36996.3},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27943.97},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":27943.97},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":36996.3},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15900.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":31782.49},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":43487.05},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16218.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16059.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16059.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24224.25,"10th_percentile":24224.25,"90th_percentile":24224.25,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":42958.55,"10th_percentile":42958.55,"90th_percentile":42958.55},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":33410.54,"10th_percentile":33410.54,"90th_percentile":33410.54,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36870.21,"10th_percentile":36870.21,"90th_percentile":37270.21,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33655.44,"10th_percentile":33655.44,"90th_percentile":33655.44,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"23","median_amount":709.49,"10th_percentile":709.49,"90th_percentile":13851.59,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31220.87,"10th_percentile":31220.87,"90th_percentile":32017.81,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":89994.0,"10th_percentile":89994.0,"90th_percentile":89994.0},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":762.46,"10th_percentile":762.46,"90th_percentile":13939.3,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"13","median_amount":762.46,"10th_percentile":709.49,"90th_percentile":13936.65,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"24","median_amount":762.46,"10th_percentile":709.49,"90th_percentile":15205.24,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"1 through 10","median_amount":709.49,"10th_percentile":709.49,"90th_percentile":709.49,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"13","median_amount":762.46,"10th_percentile":709.49,"90th_percentile":13947.24,"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."}]}]},{"description":"Cervical Spinal Fusion With Mcc","code_information":[{"code":"471","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38923.91,"maximum":108863.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":80961.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39702.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":61223.09},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":87578.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":92614.47},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":69953.38},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":69953.38},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":92614.47},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38923.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":79562.49},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":108863.04},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39702.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39313.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39313.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":90151.35},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":38923.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":94159.65},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":67823.92},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":94159.65},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39313.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40870.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40480.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39313.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":1964.18,"10th_percentile":1964.18,"90th_percentile":2528.89,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":93300.14,"10th_percentile":93300.14,"90th_percentile":93300.14,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":16496.35,"10th_percentile":16496.35,"90th_percentile":16496.35,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":18887.83,"10th_percentile":18887.83,"90th_percentile":18887.83,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":23976.55,"maximum":66419.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":49871.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24456.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":37353.6},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":53947.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":56506.2},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42680.15},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":42680.15},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":56506.2},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23976.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":48542.89},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":66419.82},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24456.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24216.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24216.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"1 through 10","median_amount":39430.9,"10th_percentile":39430.9,"90th_percentile":39430.9},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":42745.38,"10th_percentile":42745.38,"90th_percentile":42745.38,"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":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":50009.67,"10th_percentile":50009.67,"90th_percentile":50009.67,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":62113.07,"10th_percentile":62113.07,"90th_percentile":62113.07,"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":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":67233.07,"10th_percentile":67233.07,"90th_percentile":67233.07},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"11","median_amount":1171.56,"10th_percentile":1090.17,"90th_percentile":23410.02,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":53327.38,"10th_percentile":3790.0,"90th_percentile":53645.38,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1336.0,"10th_percentile":1090.17,"90th_percentile":22804.02,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1542.93,"10th_percentile":1171.56,"90th_percentile":22467.86,"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."}]}]},{"description":"Cervical Spinal Fusion Without Cc/Mcc","code_information":[{"code":"473","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19968.57,"maximum":55039.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41534.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20367.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":30953.24},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44929.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30016.26,"10th_percentile":30016.26,"90th_percentile":30016.26,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2697.67,"10th_percentile":2697.67,"90th_percentile":2697.67,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":16147.99,"10th_percentile":16147.99,"90th_percentile":16147.99,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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","code_information":[{"code":"474","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34669.8,"maximum":96783.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":72113.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35363.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":54429.68},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":78007.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":82337.82},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62191.24},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":62191.24},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":82337.82},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34669.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":70734.11},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":96783.43},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35363.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35016.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35016.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":80148.01},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":34669.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":83711.55},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":60298.07},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":83711.55},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35016.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36403.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36056.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35016.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":3224.81,"10th_percentile":3224.81,"90th_percentile":3224.81,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1687.53,"10th_percentile":1687.53,"90th_percentile":1687.53,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":18653.75,"maximum":51305.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38799.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19026.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":28853.6},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41970.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":43647.93},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32968.07},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":32968.07},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":43647.93},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18653.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":37496.71},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":51305.66},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19026.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18840.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18840.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":42487.09},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":18653.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":44376.15},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31964.48},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":44376.15},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18840.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19586.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19399.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18840.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":39293.42,"10th_percentile":39293.42,"90th_percentile":39293.42,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":14515.33,"10th_percentile":14515.33,"90th_percentile":14515.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":2000.0,"10th_percentile":872.37,"90th_percentile":19861.5,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":9955.77,"maximum":26607.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20708.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10154.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14963.76},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22400.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":22636.24},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17097.56},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":17097.56},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":22636.24},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9955.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":19446.16},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":26607.61},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10154.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10055.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10055.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22034.22},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":9955.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23013.9},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16577.09},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":23013.9},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10055.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10453.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10354.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10055.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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","code_information":[{"code":"477","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28013.91,"maximum":77883.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":58268.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28574.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":43800.87},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":63031.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":25109.96,"10th_percentile":25109.96,"90th_percentile":25109.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":47911.12,"10th_percentile":47911.12,"90th_percentile":47911.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":879.98,"10th_percentile":879.98,"90th_percentile":879.98,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":15276.36,"10th_percentile":879.98,"90th_percentile":17242.79,"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."}]}]},{"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":15344.47,"maximum":41908.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31916.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15651.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":23568.99},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34525.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27239.22,"10th_percentile":27239.22,"90th_percentile":27239.22,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":13044.0,"10th_percentile":668.2,"90th_percentile":14402.19,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":6380.69,"10th_percentile":6380.69,"90th_percentile":6380.69,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":11833.92,"10th_percentile":668.2,"90th_percentile":14735.65,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":13168.04,"10th_percentile":13168.04,"90th_percentile":13168.04,"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."}]}]},{"description":"Hip And Femur Procedures Except Major Joint With Mcc","code_information":[{"code":"480","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23708.19,"maximum":65657.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":49313.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24182.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":36925.05},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":53343.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":42560.24,"10th_percentile":42560.24,"90th_percentile":42560.24,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":1189.28,"10th_percentile":1080.31,"90th_percentile":20885.52,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":46681.64,"10th_percentile":46681.64,"90th_percentile":46681.64,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":77121.02,"10th_percentile":77121.02,"90th_percentile":77121.02},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":21023.62,"10th_percentile":21023.62,"90th_percentile":21023.62,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"16","median_amount":7535.11,"10th_percentile":1106.66,"90th_percentile":22133.07,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1525.23,"10th_percentile":904.69,"90th_percentile":22014.51,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"1 through 10","median_amount":904.69,"10th_percentile":904.69,"90th_percentile":904.69,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":21345.93,"10th_percentile":1189.28,"90th_percentile":21542.76,"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."}]}]},{"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":17215.07,"maximum":47220.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35807.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17559.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":26556.17},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38733.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":175.27,"10th_percentile":175.27,"90th_percentile":175.27,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"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":13478.41,"10th_percentile":780.76,"90th_percentile":15141.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32528.21,"10th_percentile":30423.97,"90th_percentile":34642.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"28","median_amount":4407.92,"10th_percentile":780.76,"90th_percentile":16113.77,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":37736.21,"10th_percentile":37736.21,"90th_percentile":37736.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31796.61,"10th_percentile":31796.61,"90th_percentile":31796.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":37736.21,"10th_percentile":37736.21,"90th_percentile":37736.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"45","median_amount":13870.9,"10th_percentile":780.76,"90th_percentile":17419.63,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"1 through 10","median_amount":14889.77,"10th_percentile":14889.77,"90th_percentile":14889.77,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"25","median_amount":1096.93,"10th_percentile":780.76,"90th_percentile":15342.03,"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."}]}]},{"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":13535.0,"maximum":36770.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28152.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13805.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":20679.45},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30453.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20113.97,"10th_percentile":20113.97,"90th_percentile":20113.97,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28834.35,"10th_percentile":28834.35,"90th_percentile":28834.35,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":9796.81,"10th_percentile":596.94,"90th_percentile":11347.81,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21947.98,"10th_percentile":21947.98,"90th_percentile":21947.98,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":65270.54,"10th_percentile":65270.54,"90th_percentile":65270.54},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"12","median_amount":9743.96,"10th_percentile":596.94,"90th_percentile":12216.23,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":10909.77,"10th_percentile":10909.77,"90th_percentile":10909.77,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":641.51,"10th_percentile":596.94,"90th_percentile":12941.19,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":11809.27,"10th_percentile":11809.27,"90th_percentile":11809.27,"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":"Major Joint Or Limb Reattachment Procedures Of Upper Extremities","code_information":[{"code":"483","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22593.45,"maximum":62492.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":46994.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23045.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":35144.92},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":50835.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35836.03,"10th_percentile":35836.03,"90th_percentile":35836.03,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":18772.59,"10th_percentile":18772.59,"90th_percentile":18772.59,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":26207.62,"maximum":72754.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":54511.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26731.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":40916.4},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":58967.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":61895.78},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":46751.0},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":46751.0},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":61895.78},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26207.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":53172.93},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":72754.97},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26731.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26469.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26469.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":60249.63},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":26207.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":62928.45},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45327.85},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":62928.45},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26469.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27518.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27255.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26469.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":23371.46,"10th_percentile":23371.46,"90th_percentile":23371.46,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":54133.93,"10th_percentile":54133.93,"90th_percentile":54133.93},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":17188.08,"maximum":47143.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35751.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17531.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":26513.06},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38673.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":40107.3},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30293.77},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":30293.77},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":40107.3},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17188.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":34455.05},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":47143.85},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17531.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17359.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17359.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":39040.63},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":17188.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":40776.45},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29371.59},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":40776.45},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17359.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18047.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17875.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17359.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":19626.96,"10th_percentile":19626.96,"90th_percentile":19626.96,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29234.49,"10th_percentile":29234.49,"90th_percentile":29234.49,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":15627.11,"10th_percentile":15627.11,"90th_percentile":15627.11,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_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":6659.13,"10th_percentile":6659.13,"90th_percentile":6659.13,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38572.81,"10th_percentile":38572.81,"90th_percentile":38572.81,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":15623.27,"10th_percentile":15623.27,"90th_percentile":15623.27,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":15665.27,"10th_percentile":15665.27,"90th_percentile":15665.27,"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":"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":13020.51,"maximum":35309.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27082.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13280.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19857.85},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29296.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":30039.72},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22689.54},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":22689.54},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":30039.72},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13020.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":25806.28},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":35309.98},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13280.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13150.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13150.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29240.8},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":13020.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":30540.9},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21998.85},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":30540.9},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13150.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13671.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13541.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13150.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":13547.34,"10th_percentile":13547.34,"90th_percentile":13547.34,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":28333.55,"10th_percentile":28333.55,"90th_percentile":28333.55,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":14629.89,"maximum":39879.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30430.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14922.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22427.88},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32917.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":33927.5},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25626.05},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":25626.05},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":33927.5},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14629.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":29146.17},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":39879.85},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14922.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14776.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14776.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":33025.19},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":14629.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":34493.55},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24845.97},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":34493.55},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14776.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15361.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15215.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14776.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24919.31,"10th_percentile":24919.31,"90th_percentile":24919.31,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":9452.39,"maximum":25178.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19660.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9641.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14159.91},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21267.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":21420.22},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16179.08},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":16179.08},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":21420.22},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9452.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":18401.51},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":25178.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9641.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9546.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9546.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20850.54},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":9452.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21777.6},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15686.57},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":21777.6},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9546.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9925.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9830.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9546.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":8838.26,"10th_percentile":8838.26,"90th_percentile":8838.26,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24148.8,"10th_percentile":24148.8,"90th_percentile":24148.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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","code_information":[{"code":"492","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29736.84,"maximum":82776.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":61852.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30331.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":46552.22},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":66907.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":70421.29},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":53190.47},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":53190.47},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":70421.29},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29736.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":60496.95},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":82776.22},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30331.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30034.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30034.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":24363.19,"10th_percentile":24363.19,"90th_percentile":24363.19,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":22398.2,"10th_percentile":1544.09,"90th_percentile":22773.59,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":15896.71,"10th_percentile":15896.71,"90th_percentile":15896.71,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":64585.67,"10th_percentile":64585.67,"90th_percentile":64585.67,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":25682.4,"10th_percentile":1436.02,"90th_percentile":26420.48,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":20721.26,"maximum":57176.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43100.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21135.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":32155.21},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":46622.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":1328.2,"10th_percentile":1328.2,"90th_percentile":1328.2,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":50693.47,"10th_percentile":50693.47,"90th_percentile":50693.47,"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":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":42096.72,"10th_percentile":42096.72,"90th_percentile":42096.72,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":13908.38,"10th_percentile":903.46,"90th_percentile":17632.12,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":10101.44,"10th_percentile":10101.44,"90th_percentile":10101.44,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":43984.99,"10th_percentile":43984.99,"90th_percentile":43984.99,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32583.97,"10th_percentile":32583.97,"90th_percentile":32583.97,"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":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1328.2,"10th_percentile":903.46,"90th_percentile":18934.25,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"1 through 10","median_amount":18706.76,"10th_percentile":18706.76,"90th_percentile":18706.76,"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] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":17662.17,"10th_percentile":17662.17,"90th_percentile":17662.17,"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."}]}]},{"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":16516.38,"maximum":45236.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34354.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16846.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":25440.41},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37161.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":38484.67},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29068.17},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":29068.17},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":38484.67},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16516.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":33061.1},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":45236.54},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16846.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16681.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16681.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":37461.15},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":16516.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":39126.75},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28183.3},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":39126.75},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16681.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17342.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17177.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16681.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":82095.83,"10th_percentile":82095.83,"90th_percentile":82095.83,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":762.41,"10th_percentile":709.45,"90th_percentile":14723.59,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":48368.27,"10th_percentile":48368.27,"90th_percentile":48368.27},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":33640.16,"10th_percentile":33640.16,"90th_percentile":33640.16,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31115.45,"10th_percentile":31115.45,"90th_percentile":31115.45,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1400.0,"10th_percentile":709.45,"90th_percentile":14544.38,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":1050.84,"10th_percentile":1050.84,"90th_percentile":1050.84,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":5338.2,"10th_percentile":5338.2,"90th_percentile":5338.2,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2597.0,"10th_percentile":2597.0,"90th_percentile":2597.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1050.84,"10th_percentile":709.45,"90th_percentile":15486.66,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":29372.4,"maximum":81741.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":61094.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29959.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":45970.25},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":66087.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21195.83,"10th_percentile":21195.83,"90th_percentile":21195.83,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30930.72,"10th_percentile":30930.72,"90th_percentile":30930.72,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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 Cc/Mcc","code_information":[{"code":"497","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10178.88,"maximum":27241.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21172.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10382.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15320.04},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22902.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":23175.19},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17504.64},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":17504.64},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":23175.19},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10178.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":19909.16},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":27241.12},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10382.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10280.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10280.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22558.84},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":10178.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23561.85},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16971.78},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":23561.85},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10280.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10687.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10586.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10280.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24487.68,"10th_percentile":24487.68,"90th_percentile":24487.68,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - 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PPO","methodology":"fee schedule","standard_charge_dollar":57862.22},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43704.38},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":43704.38},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":57862.22},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24537.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":49707.81},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":68013.76},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25028.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24783.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24783.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":56323.35},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":24537.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":58827.6},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42373.97},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":58827.6},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24783.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25764.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25519.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24783.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":27611.0,"10th_percentile":27611.0,"90th_percentile":27611.0},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":20495.56,"10th_percentile":20495.56,"90th_percentile":20495.56,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":22999.64,"10th_percentile":22999.64,"90th_percentile":23020.64,"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."}]}]},{"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":16582.28,"maximum":45423.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34491.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16913.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":25545.65},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37310.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":25712.98,"maximum":71350.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":53483.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26227.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":40126.5},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":57854.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":60700.86},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45848.46},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":45848.46},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":60700.86},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25712.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":52146.41},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":71350.42},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26227.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25970.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25970.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":59086.5},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":25712.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":61713.6},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44452.78},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":61713.6},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25970.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26998.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26741.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25970.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":49675.71,"10th_percentile":49675.71,"90th_percentile":49675.71,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":10617.18,"10th_percentile":10617.18,"90th_percentile":10617.18,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":"Soft Tissue Procedures With Cc","code_information":[{"code":"501","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14464.75,"maximum":39410.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30086.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14754.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22164.16},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32545.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":33528.56},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25324.72},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":25324.72},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":33528.56},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14464.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":28803.44},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":39410.91},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14754.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14609.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14609.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":32636.85},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":14464.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":34087.95},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24553.81},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":34087.95},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14609.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15187.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15043.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14609.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":915.52,"10th_percentile":915.52,"90th_percentile":915.52,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30373.68,"10th_percentile":30373.68,"90th_percentile":30373.68,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":12801.49,"10th_percentile":12801.49,"90th_percentile":12801.49,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":12141.3,"10th_percentile":671.55,"90th_percentile":17352.44,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":11271.38,"maximum":30343.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23444.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11496.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17064.67},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25360.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":25814.36},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19498.05},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":19498.05},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":25814.36},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11271.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":22176.39},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":30343.32},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11496.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11384.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11384.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25127.82},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":11271.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26245.05},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18904.51},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":26245.05},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11384.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11834.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11722.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11384.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":704.87,"10th_percentile":704.87,"90th_percentile":704.87,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":10448.51,"10th_percentile":10448.51,"90th_percentile":10448.51,"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."}]}]},{"description":"Foot Procedures With Mcc","code_information":[{"code":"503","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22745.9,"maximum":62925.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":47311.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23200.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":35388.36},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":51178.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":53533.3},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40434.67},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":40434.67},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":53533.3},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22745.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":45988.95},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":62925.35},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23200.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22973.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22973.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":52109.56},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":22745.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":54426.45},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39203.79},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":54426.45},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22973.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23883.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23655.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22973.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":19754.69,"10th_percentile":19754.69,"90th_percentile":19754.69,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":15426.25,"maximum":42141.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32086.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15734.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":23699.59},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34709.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":35851.26},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27079.1},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":27079.1},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":35851.26},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15426.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":30798.81},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":42141.11},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15734.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15580.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15580.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":34897.78},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":15426.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":36449.4},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26254.78},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":36449.4},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15580.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16197.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16043.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15580.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":71452.37,"10th_percentile":71452.37,"90th_percentile":71452.37},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":12925.78,"10th_percentile":12925.78,"90th_percentile":12925.78,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27513.14,"10th_percentile":27513.14,"90th_percentile":27513.14,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":978.94,"10th_percentile":978.94,"90th_percentile":1050.0,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":13001.97,"10th_percentile":709.69,"90th_percentile":13050.97,"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."}]}]},{"description":"Foot Procedures Without Cc/Mcc","code_information":[{"code":"505","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14819.65,"maximum":40418.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30824.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15116.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22730.91},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33344.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":34385.9},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25972.29},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":25972.29},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":34385.9},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14819.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":29539.97},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":40418.68},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15116.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14967.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14967.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":33471.4},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":14819.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":34959.6},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25181.67},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":34959.6},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14967.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15560.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15412.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14967.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":12996.33,"10th_percentile":12996.33,"90th_percentile":12996.33,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":11297.59,"maximum":30417.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23498.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11523.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17106.51},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25419.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":25877.66},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19545.86},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":19545.86},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":25877.66},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11297.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":22230.77},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":30417.71},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11523.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11410.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11410.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25189.43},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":11297.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26309.4},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18950.86},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":26309.4},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11410.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11862.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11749.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11410.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":14927.63,"maximum":40725.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31049.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15226.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22903.35},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33587.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":34646.75},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26169.32},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":26169.32},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":34646.75},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14927.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":29764.05},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":40725.29},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15226.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15076.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15076.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":33725.31},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":14927.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":35224.8},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25372.69},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":35224.8},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15076.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15674.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15524.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15076.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":12609.23,"maximum":34142.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26227.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12861.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19201.08},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28370.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":29046.19},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21939.11},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":21939.11},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":29046.19},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12609.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":24952.77},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":34142.15},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12861.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12735.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12735.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":28273.7},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":12609.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29530.8},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21271.26},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":29530.8},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12735.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13239.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13113.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12735.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16363.52,"10th_percentile":16363.52,"90th_percentile":16363.52,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":24567.27,"maximum":68097.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":51099.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25058.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":38296.92},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":55276.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":57933.19},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43757.98},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":43757.98},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":57933.19},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24567.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":49768.78},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":68097.17},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25058.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24812.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24812.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":56392.43},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":24567.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":58899.75},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42425.94},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":58899.75},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24812.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25795.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25549.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24812.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":23259.8,"10th_percentile":23259.8,"90th_percentile":23259.8,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":20946.2,"10th_percentile":20946.2,"90th_percentile":20946.2,"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."}]}]},{"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":17095.18,"maximum":46880.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35557.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17437.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":26364.71},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38464.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":39882.89},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30124.27},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":30124.27},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":39882.89},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17095.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":34262.27},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":46880.07},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17437.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17266.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17266.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":38822.19},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":17095.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":40548.3},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29207.25},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":40548.3},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17266.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17949.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17778.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17266.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":35146.42,"10th_percentile":35146.42,"90th_percentile":35146.42,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":793.06,"10th_percentile":793.06,"90th_percentile":793.06,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":12992.16,"10th_percentile":12992.16,"90th_percentile":12992.16,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":13728.73,"maximum":37320.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28555.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14003.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":20988.82},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30889.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":31750.57},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23981.78},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":23981.78},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":31750.57},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13728.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":27276.03},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":37320.99},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14003.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13866.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13866.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":30906.15},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":13728.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":32280.3},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23251.75},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":32280.3},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13866.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14415.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14277.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13866.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"1 through 10","median_amount":4909.47,"10th_percentile":4909.47,"90th_percentile":4909.47,"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: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":866.97,"10th_percentile":866.97,"90th_percentile":11527.29,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25205.48,"10th_percentile":25205.48,"90th_percentile":25205.48,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":604.99,"10th_percentile":604.99,"90th_percentile":604.99,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":13084.82,"maximum":35492.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27216.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13346.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19960.55},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29440.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":30195.07},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22806.88},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":22806.88},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":30195.07},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13084.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":25939.74},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":35492.59},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13346.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13215.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13215.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29392.02},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":13084.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":30698.85},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22112.62},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":30698.85},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13215.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13739.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13608.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13215.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20043.5,"10th_percentile":20043.5,"90th_percentile":20043.5,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":12723.81,"10th_percentile":12723.81,"90th_percentile":12723.81,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20432.5,"10th_percentile":20432.5,"90th_percentile":20432.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":8702.09,"maximum":23047.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18100.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8876.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12961.74},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19579.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19086.24},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":8702.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19934.85},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14359.23},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":19934.85},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8789.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9137.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9050.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8789.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":25888.44,"maximum":71848.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":53847.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26406.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":40406.71},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":58248.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":61124.74},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":46168.62},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":46168.62},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":61124.74},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25888.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":52510.55},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":71848.66},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26406.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26147.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26147.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":59499.1},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":25888.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":62144.55},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44763.2},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":62144.55},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26147.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27182.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26923.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26147.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":1163.62,"10th_percentile":1163.62,"90th_percentile":22831.94,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":68759.63,"10th_percentile":68759.63,"90th_percentile":68759.63,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"1 through 10","median_amount":65618.02,"10th_percentile":65618.02,"90th_percentile":65618.02},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":16361.52,"10th_percentile":16361.52,"90th_percentile":17992.8,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1163.62,"10th_percentile":924.03,"90th_percentile":21459.33,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":22391.61,"10th_percentile":1250.5,"90th_percentile":22647.14,"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":"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":17084.86,"maximum":46850.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35536.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17426.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":26348.23},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38440.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":39857.96},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30105.43},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":30105.43},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":39857.96},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17084.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":34240.85},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":46850.76},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17426.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17255.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17255.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":38797.92},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":17084.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":40522.95},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29188.99},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":40522.95},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17255.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17939.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17768.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17255.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":14772.44,"10th_percentile":14772.44,"90th_percentile":14772.44,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":813.49,"10th_percentile":756.97,"90th_percentile":16910.76,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36691.4,"10th_percentile":36691.4,"90th_percentile":36691.4,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":13177.32,"10th_percentile":756.97,"90th_percentile":14251.36,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29733.43,"10th_percentile":29733.43,"90th_percentile":29733.43,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":12268.18,"10th_percentile":756.97,"90th_percentile":17345.29,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_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":5981.89,"10th_percentile":5981.89,"90th_percentile":5981.89,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":6380.69,"10th_percentile":6380.69,"90th_percentile":6380.69,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":813.49,"10th_percentile":756.97,"90th_percentile":16121.77,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":813.49,"10th_percentile":756.97,"90th_percentile":14888.28,"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":"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":12786.29,"maximum":34644.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26595.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13042.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19483.82},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28769.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":29473.91},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22262.17},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":22262.17},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":29473.91},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12786.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":25320.21},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":34644.9},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13042.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12914.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12914.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":28690.04},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":12786.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29965.65},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21584.49},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":29965.65},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12914.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13425.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13297.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12914.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":11653.15,"10th_percentile":11653.15,"90th_percentile":11653.15,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"1 through 10","median_amount":24796.15,"10th_percentile":24796.15,"90th_percentile":24796.15},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25369.19,"10th_percentile":25369.19,"90th_percentile":25369.19,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":11048.03,"10th_percentile":11048.03,"90th_percentile":11048.03,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":804.81,"10th_percentile":804.81,"90th_percentile":11094.24,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29965.65,"10th_percentile":29965.65,"90th_percentile":29965.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":752.33,"10th_percentile":561.68,"90th_percentile":11259.87,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":752.33,"10th_percentile":752.33,"90th_percentile":752.33,"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."}]}]},{"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":30258.48,"maximum":84257.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62937.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30863.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":47385.23},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":68081.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":71681.41},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":54142.27},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":54142.27},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":71681.41},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30258.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":61579.49},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":84257.43},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30863.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30561.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30561.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":22813.8,"10th_percentile":22813.8,"90th_percentile":22813.8,"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."}]}]},{"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":16466.36,"maximum":45094.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34250.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16795.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":25360.54},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37049.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":38363.84},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28976.9},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":28976.9},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":38363.84},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16466.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":32957.3},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":45094.51},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16795.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16631.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16631.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":37343.53},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":16466.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":39003.9},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28094.81},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":39003.9},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16631.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17289.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17125.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16631.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":31868.65,"10th_percentile":31868.65,"90th_percentile":31868.65,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":6360.0,"10th_percentile":1047.54,"90th_percentile":21057.64,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25001.72,"10th_percentile":25001.72,"90th_percentile":25001.72,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38647.86,"10th_percentile":38647.86,"90th_percentile":38647.86,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":742.0,"10th_percentile":742.0,"90th_percentile":742.0,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35862.95,"10th_percentile":35862.95,"90th_percentile":35862.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27697.31,"10th_percentile":27697.31,"90th_percentile":27697.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":9707.92,"10th_percentile":9707.92,"90th_percentile":9707.92,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20209.74,"10th_percentile":20209.74,"90th_percentile":20209.74,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"1 through 10","median_amount":5307.56,"10th_percentile":5307.56,"90th_percentile":5307.56,"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":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":579.55,"10th_percentile":579.55,"90th_percentile":579.55,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33096.73,"10th_percentile":33096.73,"90th_percentile":33096.73,"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":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":23373.93,"maximum":64708.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48617.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23841.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":36391.27},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52591.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":21197.41,"10th_percentile":21197.41,"90th_percentile":21197.41,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1503.18,"10th_percentile":1120.0,"90th_percentile":21848.82,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1503.18,"10th_percentile":1159.66,"90th_percentile":21915.14,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"1 through 10","median_amount":22619.18,"10th_percentile":22619.18,"90th_percentile":22619.18,"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] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":17399.28,"maximum":47743.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36190.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17747.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":26850.32},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39148.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":40617.49},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30679.12},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":30679.12},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":40617.49},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17399.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":34893.34},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":47743.55},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17747.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17573.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17573.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":37351.76,"10th_percentile":37351.76,"90th_percentile":37351.76,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":37688.09,"10th_percentile":37688.09,"90th_percentile":38449.64,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27263.05,"10th_percentile":27263.05,"90th_percentile":27263.05,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":14282.51,"10th_percentile":793.25,"90th_percentile":15440.38,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"1 through 10","median_amount":1669.72,"10th_percentile":1669.72,"90th_percentile":1669.72},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"18","median_amount":15331.21,"10th_percentile":793.25,"90th_percentile":16285.29,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"22","median_amount":13978.35,"10th_percentile":793.25,"90th_percentile":16834.99,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"1 through 10","median_amount":14204.22,"10th_percentile":14204.22,"90th_percentile":14204.22,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"14","median_amount":1050.0,"10th_percentile":793.25,"90th_percentile":15566.16,"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."}]}]},{"description":"Fractures Of Femur With Mcc","code_information":[{"code":"533","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13032.42,"maximum":35343.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27107.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13293.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19876.87},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29322.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":30068.49},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22711.27},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":22711.27},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":30068.49},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13032.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":25830.99},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":35343.8},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13293.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13162.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13162.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29268.8},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":13032.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":30570.15},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22019.91},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":30570.15},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13162.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13684.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13553.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13162.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":12705.63,"10th_percentile":12705.63,"90th_percentile":12705.63,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":4315.68,"10th_percentile":4315.68,"90th_percentile":4315.68,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":13194.93,"10th_percentile":13194.93,"90th_percentile":13194.93,"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":"Fractures Of Femur Without Mcc","code_information":[{"code":"534","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6985.51,"maximum":18173.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14529.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7125.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10220.54},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15717.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":15461.0},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11677.97},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":11677.97},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":15461.0},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6985.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":13282.11},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":18173.52},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7125.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7055.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7055.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15049.81},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":6985.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15718.95},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11322.48},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":15718.95},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7055.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7334.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7264.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7055.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":6315.88,"10th_percentile":6315.88,"90th_percentile":6315.88,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":4283.87,"10th_percentile":4283.87,"90th_percentile":4283.87,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":70.71,"10th_percentile":70.71,"90th_percentile":70.71,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":65.5,"10th_percentile":65.5,"90th_percentile":65.5,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":10764.04,"maximum":28902.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22389.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10979.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16254.48},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24219.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":24588.76},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18572.33},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":18572.33},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":24588.76},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10764.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":21123.51},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":28902.69},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10979.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10871.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10871.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":9744.63,"10th_percentile":9744.63,"90th_percentile":9744.63,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":9818.04,"10th_percentile":537.78,"90th_percentile":12904.79,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":8571.64,"10th_percentile":500.42,"90th_percentile":12219.33,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":6997.42,"maximum":18207.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14554.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7137.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10239.56},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15744.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":305.13,"10th_percentile":305.13,"90th_percentile":305.13,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":6218.18,"10th_percentile":6218.18,"90th_percentile":6218.18,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"16","median_amount":305.13,"10th_percentile":71.41,"90th_percentile":6252.52,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":4765.08,"10th_percentile":305.13,"90th_percentile":8274.58,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"12","median_amount":6211.26,"10th_percentile":305.13,"90th_percentile":6267.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"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":8162.18,"maximum":21514.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16977.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8325.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12099.57},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18364.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":6304.28,"maximum":16239.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13112.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6430.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9132.68},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14184.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":13815.35},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10434.99},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":10434.99},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":13815.35},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6304.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":11868.38},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":16239.16},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6430.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6367.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6367.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":16224.19,"maximum":44406.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33746.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16548.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":24973.83},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36504.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":36774.1},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":16224.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":38409.15},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27666.41},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":38409.15},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16386.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17035.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16873.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16386.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":3743.39,"10th_percentile":3743.39,"90th_percentile":3743.39,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":10877.57,"maximum":29225.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22625.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11095.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16435.79},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24474.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":24863.03},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18779.5},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":18779.5},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":24863.03},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10877.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":21359.14},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":29225.08},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11095.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10986.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10986.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":24201.79},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":10877.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25277.85},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18207.83},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":25277.85},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10986.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11421.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11312.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10986.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":1140.0,"10th_percentile":1140.0,"90th_percentile":1140.0,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":4232.05,"10th_percentile":4232.05,"90th_percentile":4232.05,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":10223.96,"10th_percentile":10223.96,"90th_percentile":10223.96,"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."}]}]},{"description":"Osteomyelitis Without Cc/Mcc","code_information":[{"code":"541","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6837.04,"maximum":17751.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14221.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6973.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9983.44},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15383.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":15102.33},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11407.06},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":11407.06},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":15102.33},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6837.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":12973.99},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":17751.93},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6973.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6905.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6905.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14700.68},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":6837.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15354.3},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11059.82},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":15354.3},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6905.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7178.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7110.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6905.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16865.81,"10th_percentile":16865.81,"90th_percentile":16865.81,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":14610.84,"maximum":39825.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30390.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14903.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22397.45},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32874.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":33881.47},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25591.29},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":25591.29},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":33881.47},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14610.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":29106.62},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":39825.74},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14903.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14756.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14756.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23965.6,"10th_percentile":23965.6,"90th_percentile":23965.6,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29239.17,"10th_percentile":29239.17,"90th_percentile":29239.17,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":78107.9,"10th_percentile":78107.9,"90th_percentile":78107.9},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":8747.34,"maximum":23176.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18194.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8922.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13034.01},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19681.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":19717.04},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14892.64},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":14892.64},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":19717.04},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8747.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":16938.36},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":23176.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8922.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8834.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8834.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":19352.84,"10th_percentile":19352.84,"90th_percentile":19352.84,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14623.45,"10th_percentile":14623.45,"90th_percentile":14623.45,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":4302.64,"10th_percentile":429.0,"90th_percentile":7889.27,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16631.73,"10th_percentile":16631.73,"90th_percentile":16631.73,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":4697.96,"10th_percentile":399.2,"90th_percentile":8042.87,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":6217.54,"10th_percentile":6217.54,"90th_percentile":6217.54,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18291.78,"10th_percentile":18291.78,"90th_percentile":18291.78,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":61864.08,"10th_percentile":61864.08,"90th_percentile":61864.08,"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":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"14","median_amount":7087.27,"10th_percentile":399.2,"90th_percentile":8209.69,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":399.2,"10th_percentile":342.16,"90th_percentile":8062.05,"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":"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":6576.62,"maximum":17012.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13679.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6708.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9567.57},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14797.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":14473.23},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10931.89},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":10931.89},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":14473.23},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6576.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":12433.54},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":17012.46},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6708.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6642.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6642.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14088.31},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":6576.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14714.7},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10599.11},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":14714.7},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6642.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6905.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6839.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6642.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":727.32,"10th_percentile":727.32,"90th_percentile":36503.0,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":5766.83,"10th_percentile":5766.83,"90th_percentile":5766.83,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":5829.68,"10th_percentile":5829.68,"90th_percentile":5829.68,"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":"Connective Tissue Disorders With Mcc","code_information":[{"code":"545","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20289.34,"maximum":55949.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42201.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20695.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":31465.47},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45651.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":47599.01},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35952.39},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":35952.39},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":47599.01},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20289.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":40890.97},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":55949.93},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20695.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20492.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20492.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":46333.09},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":20289.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":48393.15},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34857.96},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":48393.15},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20492.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21303.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21100.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20492.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":18563.32,"10th_percentile":18563.32,"90th_percentile":18563.32,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":16521.55,"10th_percentile":16521.55,"90th_percentile":28518.89,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1299.72,"10th_percentile":1299.72,"90th_percentile":1299.72,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":9742.98,"maximum":26003.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20265.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9937.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14623.96},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21921.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":22122.21},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16709.31},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":16709.31},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":22122.21},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9742.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":19004.57},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":26003.4},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9937.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9840.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9840.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21533.86},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":9742.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22491.3},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16200.66},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":22491.3},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9840.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10230.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10132.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9840.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":1446.48,"10th_percentile":1446.48,"90th_percentile":1446.48,"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":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":435.63,"10th_percentile":435.63,"90th_percentile":5343.39,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14678.48,"10th_percentile":14678.48,"90th_percentile":14678.48,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"1 through 10","median_amount":12563.32,"10th_percentile":12563.32,"90th_percentile":12563.32},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18149.26,"10th_percentile":18149.26,"90th_percentile":18149.26,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_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":435.63,"10th_percentile":435.63,"90th_percentile":435.63,"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":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":2904.47,"10th_percentile":2904.47,"90th_percentile":2904.47,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9711.15,"10th_percentile":9711.15,"90th_percentile":9711.15,"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":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":468.15,"10th_percentile":435.63,"90th_percentile":8288.55,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":468.15,"10th_percentile":468.15,"90th_percentile":468.15,"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."}]}]},{"description":"Connective Tissue Disorders Without Cc/Mcc","code_information":[{"code":"547","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7224.5,"maximum":18852.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15026.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7368.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10602.18},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16255.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":16038.32},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12114.03},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":12114.03},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":16038.32},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7224.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":13778.07},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":18852.13},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7368.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7296.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7296.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15611.77},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":7224.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16305.9},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11745.27},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":16305.9},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7296.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7585.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7513.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7296.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10481.13,"10th_percentile":10481.13,"90th_percentile":10481.13,"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":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":15916.13,"maximum":43532.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33105.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16234.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":24481.88},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35811.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":37034.66},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27972.95},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":27972.95},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":37034.66},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15916.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":31815.44},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":43532.14},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16234.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16075.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16075.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":36049.71},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":15916.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":37652.55},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27121.42},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":37652.55},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16075.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16711.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16552.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16075.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":10170.14,"maximum":27216.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21153.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10373.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15306.09},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22882.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":23154.1},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17488.71},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":17488.71},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":23154.1},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10170.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":19891.03},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":27216.32},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10373.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10271.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10271.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22538.3},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":10170.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23540.4},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16956.33},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":23540.4},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10271.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10678.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10576.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10271.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":487.31,"10th_percentile":487.31,"90th_percentile":487.31,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":2773.13,"10th_percentile":2773.13,"90th_percentile":2773.13,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":7525.42,"maximum":19706.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15652.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7675.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11082.71},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16932.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":16765.24},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12663.09},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":12663.09},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":16765.24},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7525.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":14402.55},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":19706.58},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7675.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7600.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7600.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":13893.09,"maximum":37787.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28897.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14170.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":21251.27},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31259.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":32147.6},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24281.66},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":24281.66},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":32147.6},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13893.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":27617.1},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":37787.67},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14170.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14032.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14032.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":10529.72,"10th_percentile":690.03,"90th_percentile":16219.86,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_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":300.03,"10th_percentile":300.03,"90th_percentile":300.03,"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":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"12","median_amount":7203.39,"10th_percentile":642.1,"90th_percentile":15818.56,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":8107.06,"10th_percentile":8107.06,"90th_percentile":8107.06,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":8100.92,"10th_percentile":8100.92,"90th_percentile":8100.92,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"15","median_amount":5727.1,"10th_percentile":642.1,"90th_percentile":12672.66,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":12572.1,"10th_percentile":12572.1,"90th_percentile":12572.1,"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":"Medical Back Problems Without Mcc","code_information":[{"code":"552","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8217.76,"maximum":21672.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17092.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8382.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12188.32},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18489.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":18437.73},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13926.35},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":13926.35},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":18437.73},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8217.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":15839.34},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":21672.51},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8382.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8299.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8299.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17947.37},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":8217.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18745.35},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13502.42},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":18745.35},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8299.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8628.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8546.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8299.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"21","median_amount":389.74,"10th_percentile":362.67,"90th_percentile":7336.46,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13810.02,"10th_percentile":13810.02,"90th_percentile":13810.02,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"1 through 10","median_amount":27991.28,"10th_percentile":27991.28,"90th_percentile":27991.28},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":17687.68,"10th_percentile":17687.68,"90th_percentile":17796.44,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18574.24,"10th_percentile":17578.75,"90th_percentile":20162.91,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":13285.02,"10th_percentile":11152.49,"90th_percentile":14029.21,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":362.67,"10th_percentile":250.13,"90th_percentile":6545.8,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14509.49,"10th_percentile":10957.15,"90th_percentile":17578.75,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"1 through 10","median_amount":31802.11,"10th_percentile":31802.11,"90th_percentile":31802.11},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"1 through 10","median_amount":3805.85,"10th_percentile":3805.85,"90th_percentile":3805.85,"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":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"28","median_amount":362.67,"10th_percentile":250.13,"90th_percentile":7335.4,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":23119.98,"10th_percentile":23119.98,"90th_percentile":23119.98},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":4906.62,"10th_percentile":4906.62,"90th_percentile":4906.62,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17528.63,"10th_percentile":1446.48,"90th_percentile":17528.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"43","median_amount":389.74,"10th_percentile":280.72,"90th_percentile":7339.72,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"1 through 10","median_amount":5446.44,"10th_percentile":5446.44,"90th_percentile":5446.44,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"17","median_amount":389.74,"10th_percentile":362.67,"90th_percentile":7336.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Bone Diseases And Arthropathies With Mcc","code_information":[{"code":"553","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10877.57,"maximum":29225.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22625.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11095.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16435.79},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24474.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":24201.79},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":10877.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25277.85},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18207.83},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":25277.85},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10986.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11421.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11312.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10986.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":22547.29,"10th_percentile":22547.29,"90th_percentile":22547.29,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_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":491.43,"10th_percentile":491.43,"90th_percentile":491.43,"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":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":491.43,"10th_percentile":491.43,"90th_percentile":9883.5,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":491.43,"10th_percentile":491.43,"90th_percentile":1050.0,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":7176.07,"maximum":18714.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14926.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7319.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10524.84},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16146.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":15921.32},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12025.66},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":12025.66},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":15921.32},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7176.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":13677.56},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":18714.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7319.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7247.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7247.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15497.88},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":7176.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16186.95},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11659.58},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":16186.95},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7247.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7534.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7463.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7247.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":434.74,"10th_percentile":337.49,"90th_percentile":6390.2,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":16774.83,"10th_percentile":16774.83,"90th_percentile":16774.83,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10804.13,"10th_percentile":10804.13,"90th_percentile":10804.13,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":5691.58,"10th_percentile":5691.58,"90th_percentile":5691.58,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10347.31,"10th_percentile":10347.31,"90th_percentile":10347.31,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":9459.09,"10th_percentile":9459.09,"90th_percentile":9459.09},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1050.0,"10th_percentile":337.49,"90th_percentile":12098.49,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"13","median_amount":434.74,"10th_percentile":314.05,"90th_percentile":6401.37,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":11080.04,"maximum":29799.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23046.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11301.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16759.1},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24930.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":25352.12},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19148.92},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":19148.92},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":25352.12},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11080.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":21779.3},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":29799.98},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11301.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11190.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11190.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":24677.87},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":11080.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25775.1},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18566.0},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":25775.1},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11190.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11634.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11523.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11190.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":2674.0,"10th_percentile":506.71,"90th_percentile":4615.52,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":544.54,"10th_percentile":544.54,"90th_percentile":544.54,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":7180.04,"maximum":18725.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14934.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7323.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10531.18},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16155.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":15930.91},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12032.9},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":12032.9},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":15930.91},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7180.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":13685.8},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":18725.88},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7323.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7251.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7251.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"1 through 10","median_amount":18586.51,"10th_percentile":18586.51,"90th_percentile":18586.51},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":15481.67,"10th_percentile":15481.67,"90th_percentile":15481.67,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1993.09,"10th_percentile":1993.09,"90th_percentile":1993.09,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":4841.71,"10th_percentile":4841.71,"90th_percentile":4841.71,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8640.22,"10th_percentile":8640.22,"90th_percentile":10550.27,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":6206.71,"10th_percentile":6206.71,"90th_percentile":6206.71,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":585.4,"10th_percentile":307.24,"90th_percentile":6337.85,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14849.69,"10th_percentile":14849.69,"90th_percentile":14849.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":4745.42,"10th_percentile":4745.42,"90th_percentile":4745.42,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"1 through 10","median_amount":5929.78,"10th_percentile":5929.78,"90th_percentile":5929.78,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":6198.91,"10th_percentile":330.17,"90th_percentile":6286.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Tendonitis, Myositis And Bursitis With Mcc","code_information":[{"code":"557","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12390.89,"maximum":33522.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25773.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12638.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18852.41},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27879.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":28518.74},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21540.72},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":21540.72},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":28518.74},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12390.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":24499.65},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":33522.16},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12638.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12514.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12514.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":400.0,"10th_percentile":400.0,"90th_percentile":400.0,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":9977.51,"10th_percentile":9977.51,"90th_percentile":9977.51,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":7677.06,"maximum":20137.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15968.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7830.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11324.88},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17273.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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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: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":12600.53,"10th_percentile":12600.53,"90th_percentile":12600.53},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":15985.76,"10th_percentile":15766.83,"90th_percentile":18175.01,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12685.36,"10th_percentile":12685.36,"90th_percentile":12685.36,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10793.49,"10th_percentile":10793.49,"90th_percentile":10793.49,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":467.78,"10th_percentile":349.3,"90th_percentile":6626.34,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":2220.09,"10th_percentile":2220.09,"90th_percentile":2220.09,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":3789.76,"10th_percentile":3789.76,"90th_percentile":4226.64,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15709.93,"10th_percentile":15709.93,"90th_percentile":16844.1,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":6600.76,"10th_percentile":467.78,"90th_percentile":7203.75,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":15392.11,"maximum":42044.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32015.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15699.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":23645.07},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34632.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":12807.95,"10th_percentile":12807.95,"90th_percentile":12807.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":10829.2,"10th_percentile":10829.2,"90th_percentile":13706.07,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":9526.23,"maximum":25387.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19814.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9716.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14277.82},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21434.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":21598.6},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16313.81},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":16313.81},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":21598.6},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9526.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":18554.75},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":25387.92},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9716.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9621.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9621.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21024.17},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":9526.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21958.95},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15817.2},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":21958.95},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9621.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10002.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9907.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9621.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3723.0,"10th_percentile":3723.0,"90th_percentile":3723.0,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17204.15,"10th_percentile":17204.15,"90th_percentile":17204.15,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"1 through 10","median_amount":3294.21,"10th_percentile":3294.21,"90th_percentile":3294.21},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":589.76,"10th_percentile":589.76,"90th_percentile":8916.0,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":460.46,"10th_percentile":460.46,"90th_percentile":460.46,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc","code_information":[{"code":"561","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6968.05,"maximum":18123.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14493.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7107.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10192.65},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15678.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":15418.8},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11646.1},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":11646.1},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":15418.8},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6968.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":13245.86},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":18123.93},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7107.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7037.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7037.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15008.73},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":6968.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15676.05},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11291.58},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":15676.05},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7037.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7316.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7246.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7037.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":8432.73,"10th_percentile":8432.73,"90th_percentile":8432.73,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":11897.83,"maximum":32122.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24747.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12135.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18065.04},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26770.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26600.87},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":11897.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":27783.6},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20012.74},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":27783.6},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12016.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12492.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12373.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12016.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":550.69,"10th_percentile":550.69,"90th_percentile":11011.46,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":9985.59,"10th_percentile":9985.59,"90th_percentile":9985.59,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":591.81,"10th_percentile":193.0,"90th_percentile":10786.53,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":8909.26,"10th_percentile":550.69,"90th_percentile":11154.96,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":585.0,"10th_percentile":537.26,"90th_percentile":10940.33,"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."}]}]},{"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":7695.33,"maximum":20189.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16006.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7849.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11354.04},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17314.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":17175.69},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12973.11},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":12973.11},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":17175.69},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7695.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":14755.15},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":20189.05},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7849.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7772.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7772.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16718.9},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":7695.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17462.25},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12578.19},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":17462.25},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7772.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8080.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8003.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7772.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":15271.83,"10th_percentile":15271.83,"90th_percentile":15271.83,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":468.99,"10th_percentile":336.33,"90th_percentile":7300.92,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":160.74,"10th_percentile":160.74,"90th_percentile":160.74,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6320.14,"10th_percentile":6320.14,"90th_percentile":6320.14,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":336.33,"10th_percentile":70.3,"90th_percentile":6649.64,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8289.89,"10th_percentile":8289.89,"90th_percentile":8289.89,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":16282.77,"10th_percentile":16282.77,"90th_percentile":16282.77},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"1 through 10","median_amount":2262.84,"10th_percentile":2262.84,"90th_percentile":2262.84,"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":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"24","median_amount":468.99,"10th_percentile":258.17,"90th_percentile":7195.49,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":2220.09,"10th_percentile":2220.09,"90th_percentile":2220.09,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7721.05,"10th_percentile":7721.05,"90th_percentile":7721.05,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12129.76,"10th_percentile":12129.76,"90th_percentile":12129.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":361.43,"10th_percentile":258.17,"90th_percentile":4933.53,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"14","median_amount":361.43,"10th_percentile":70.71,"90th_percentile":6836.76,"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."}]}]},{"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":12841.07,"maximum":34800.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26709.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13097.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19571.3},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28892.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":28818.86},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":12841.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":30100.2},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21681.41},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":30100.2},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12969.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13483.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13354.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12969.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":9529.03,"10th_percentile":590.47,"90th_percentile":10954.03,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":19269.68,"10th_percentile":19269.68,"90th_percentile":19269.68,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15985.84,"10th_percentile":15985.84,"90th_percentile":15985.84,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":7725.05,"10th_percentile":7725.05,"90th_percentile":7725.05,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":7695.54,"10th_percentile":7695.54,"90th_percentile":12302.0,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":383.7,"10th_percentile":383.7,"90th_percentile":383.7,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"1 through 10","median_amount":510.32,"10th_percentile":510.32,"90th_percentile":510.32,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":510.32,"10th_percentile":510.32,"90th_percentile":7764.75,"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."}]}]},{"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":6534.54,"maximum":16892.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13591.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6665.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9500.37},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14702.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":14371.57},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10855.11},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":10855.11},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":14371.57},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6534.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":12346.22},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":16892.97},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6665.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6599.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6599.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13989.36},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":6534.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14611.35},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10524.67},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":14611.35},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6599.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6861.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6795.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6599.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":7177.06,"10th_percentile":7177.06,"90th_percentile":7177.06,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14559.69,"10th_percentile":14559.69,"90th_percentile":14559.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":23936.86,"maximum":66307.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":49788.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24415.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":37290.21},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":53857.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1132.69,"10th_percentile":1132.69,"90th_percentile":1132.69,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":13999.48,"maximum":38089.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29118.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14279.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":21421.17},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31498.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":32404.61},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24475.79},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":24475.79},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":32404.61},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13999.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":27837.89},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":38089.78},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14279.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14139.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14139.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":31542.8},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":13999.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":32945.25},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23730.72},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":32945.25},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14139.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14699.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14559.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14139.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":28263.16,"10th_percentile":28263.16,"90th_percentile":28263.16,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":31254.62,"10th_percentile":31254.62,"90th_percentile":31254.62,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15643.75,"10th_percentile":15643.75,"90th_percentile":15643.75,"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":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":12435.66,"10th_percentile":12435.66,"90th_percentile":12435.66,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":2302.75,"10th_percentile":2302.75,"90th_percentile":2302.75,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1050.0,"10th_percentile":1050.0,"90th_percentile":1050.0,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":9686.61,"maximum":25843.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20148.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9880.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14533.94},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21794.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":21986.03},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16606.45},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":16606.45},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":21986.03},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9686.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":18887.59},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":25843.33},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9880.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9783.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9783.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21401.31},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":9686.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22352.85},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16100.93},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":22352.85},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9783.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10170.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10074.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9783.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":22717.08,"10th_percentile":22717.08,"90th_percentile":22717.08,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":8514.97,"10th_percentile":8514.97,"90th_percentile":8514.97,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":52601.7,"maximum":147701.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":109411.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53653.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":83065.2},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":118353.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":125655.85},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":94910.13},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":94910.13},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":125655.85},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52601.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":107947.42},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":147701.31},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53653.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53127.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53127.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":122313.98},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":52601.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":127752.3},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":92020.96},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":127752.3},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53127.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55231.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54705.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53127.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":28147.3,"maximum":78262.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":58546.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28710.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":44013.88},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":63331.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":66581.45},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":50290.17},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":50290.17},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":66581.45},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28147.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":57198.26},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":78262.71},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28710.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28428.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28428.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":64810.69},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":28147.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":67692.3},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48759.28},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":67692.3},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28428.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29554.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29273.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28428.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":47760.18,"10th_percentile":47760.18,"90th_percentile":47760.18,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":25282.83,"10th_percentile":25282.83,"90th_percentile":25282.83,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":14853.0,"maximum":40513.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30894.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15150.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22784.16},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33419.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":34466.46},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26033.14},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":26033.14},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":34466.46},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14853.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":29609.17},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":40513.37},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15150.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15001.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15001.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":33549.81},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":14853.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":35041.5},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25240.66},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":35041.5},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15001.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15595.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15447.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15001.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":39499.54,"maximum":110497.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":82159.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40289.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":62142.31},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":88873.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":94005.02},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":71003.68},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":71003.68},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":94005.02},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39499.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":80757.07},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":110497.55},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40289.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39894.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39894.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":19338.78,"10th_percentile":19338.78,"90th_percentile":19338.78,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":13339.69,"maximum":36216.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27746.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13606.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":20367.55},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30014.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":30810.75},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23271.92},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":23271.92},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":30810.75},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13339.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":26468.65},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":36216.29},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13606.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13473.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13473.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29991.33},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":13339.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":31324.8},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22563.49},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":31324.8},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13473.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14006.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13873.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13473.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":26298.13,"maximum":73011.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":54700.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26824.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":41060.94},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":59170.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":62114.43},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":46916.15},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":46916.15},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":62114.43},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26298.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":53360.76},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":73011.98},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26824.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26561.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26561.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":55297.49,"10th_percentile":55297.49,"90th_percentile":55297.49,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1226.46,"10th_percentile":1226.46,"90th_percentile":151108.37,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":59278.71,"10th_percentile":59278.71,"90th_percentile":59278.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":14305.16,"maximum":38957.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29754.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14591.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":21909.31},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32186.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23751.87,"10th_percentile":23751.87,"90th_percentile":23751.87,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":32891.22,"10th_percentile":32891.22,"90th_percentile":32891.22,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":716.96,"10th_percentile":512.13,"90th_percentile":11553.83,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22952.7,"10th_percentile":22952.7,"90th_percentile":22952.7,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":12469.29,"10th_percentile":12469.29,"90th_percentile":13115.48,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":904.99,"10th_percentile":904.99,"90th_percentile":904.99,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":12043.13,"maximum":32534.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25049.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12283.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18297.06},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27097.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":27678.66},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20906.19},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":20906.19},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":27678.66},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12043.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":23777.96},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":32534.69},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12283.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12163.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12163.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26942.53},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":12043.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":28140.45},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20269.78},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":28140.45},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12163.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12645.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12524.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12163.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":10847.56,"10th_percentile":10847.56,"90th_percentile":10847.56,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":3173.1,"10th_percentile":3173.1,"90th_percentile":3173.1,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":15881.99,"maximum":43435.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33034.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16199.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":24427.36},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35734.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":36952.19},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27910.65},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":27910.65},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":36952.19},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15881.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":31744.59},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":43435.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16199.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16040.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16040.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":14276.58,"maximum":38876.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29695.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14562.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":21863.67},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32122.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":17581.89,"maximum":48262.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36570.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17933.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":27141.94},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39559.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":41058.63},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31012.32},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":31012.32},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":41058.63},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17581.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":35272.31},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":48262.08},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17933.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17757.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17757.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":39966.65},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":17581.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":41743.65},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30068.27},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":41743.65},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17757.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18460.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18285.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17757.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":36627.75,"10th_percentile":36627.75,"90th_percentile":36627.75,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":15901.84,"maximum":43491.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33075.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16219.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":24459.06},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35779.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":37000.14},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27946.87},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":27946.87},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":37000.14},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15901.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":31785.78},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":43491.56},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16219.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16060.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16060.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":4321.95,"10th_percentile":4321.95,"90th_percentile":4321.95,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":5995.25,"10th_percentile":5995.25,"90th_percentile":5995.25,"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."}]}]},{"description":"Skin Ulcers With Cc","code_information":[{"code":"593","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10004.2,"maximum":26745.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20808.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10204.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15041.1},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22509.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":22753.23},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17185.93},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":17185.93},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":22753.23},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10004.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":19546.67},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":26745.13},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10204.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10104.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10104.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22148.1},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":10004.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23132.85},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16662.77},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":23132.85},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10104.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10504.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10404.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10104.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":9175.56,"10th_percentile":9175.56,"90th_percentile":9175.56,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":9120.91,"10th_percentile":9120.91,"90th_percentile":9120.91,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":591.71,"10th_percentile":302.22,"90th_percentile":8129.28,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":4199.65,"10th_percentile":4199.65,"90th_percentile":4199.65,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":9164.25,"10th_percentile":460.08,"90th_percentile":9195.85,"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":"Skin Ulcers Without Cc/Mcc","code_information":[{"code":"594","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7467.46,"maximum":19542.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15532.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7616.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10990.16},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16801.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":16625.22},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12557.33},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":12557.33},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":16625.22},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7467.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":14282.26},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":19542.01},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7616.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7542.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7542.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16183.07},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":7467.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16902.6},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12175.07},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":16902.6},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7542.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7840.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7766.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7542.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":17423.09,"maximum":47811.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36240.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17771.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":26888.36},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39201.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":40675.03},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30722.58},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":30722.58},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":40675.03},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17423.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":34942.77},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":47811.18},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17771.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17597.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17597.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":39593.26},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":17423.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":41353.65},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29787.35},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":41353.65},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17597.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18294.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18120.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17597.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3895.45,"10th_percentile":3895.45,"90th_percentile":3895.45,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":700.0,"10th_percentile":700.0,"90th_percentile":700.0,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":9180.06,"maximum":24404.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19094.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9363.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13725.02},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20655.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":20762.35},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15682.18},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":15682.18},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":20762.35},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9180.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":17836.35},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":24404.96},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9363.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9271.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9271.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20210.17},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":9180.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21108.75},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15204.8},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":21108.75},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9271.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9639.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9547.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9271.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":636.0,"10th_percentile":636.0,"90th_percentile":636.0,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13257.14,"10th_percentile":13257.14,"90th_percentile":13257.14,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"1 through 10","median_amount":1972.1,"10th_percentile":1972.1,"90th_percentile":1972.1,"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":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":406.8,"10th_percentile":406.8,"90th_percentile":406.8,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":4308.28,"10th_percentile":4308.28,"90th_percentile":4308.28,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":700.0,"10th_percentile":406.8,"90th_percentile":8324.57,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":13821.63,"maximum":37584.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28748.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14098.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":21137.16},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31098.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":31974.98},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24151.28},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":24151.28},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":31974.98},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13821.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":27468.81},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":37584.77},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14098.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13959.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13959.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":31124.59},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":13821.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":32508.45},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23416.09},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":32508.45},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13959.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14512.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14374.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13959.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23834.57,"10th_percentile":23834.57,"90th_percentile":23834.57,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":12877.54,"10th_percentile":12877.54,"90th_percentile":12877.54,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27539.79,"10th_percentile":27539.79,"90th_percentile":27539.79,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_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":661.02,"10th_percentile":661.02,"90th_percentile":661.02,"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":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":9567.52,"maximum":25505.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19900.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9758.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14343.75},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21526.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":21698.33},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16389.14},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":16389.14},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":21698.33},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9567.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":18640.43},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":25505.16},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9758.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9663.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9663.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21121.26},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":9567.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22060.35},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15890.24},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":22060.35},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9663.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10045.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9950.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9663.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16510.19,"10th_percentile":16510.19,"90th_percentile":16510.19,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":6694.13,"maximum":17346.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13923.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6828.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9755.22},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15061.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":14757.09},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11146.3},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":11146.3},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":14757.09},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6694.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":12677.4},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":17346.12},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6828.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6761.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6761.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14364.62},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":6694.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15003.3},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10806.99},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":15003.3},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6761.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7028.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6961.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6761.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":8855.32,"maximum":23482.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18419.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9032.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13206.45},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19924.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":19977.89},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15089.66},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":15089.66},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":19977.89},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8855.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":17162.44},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":23482.87},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9032.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8943.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8943.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19446.57},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":8855.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20311.2},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14630.31},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":20311.2},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8943.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9298.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9209.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8943.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":2461.27,"10th_percentile":2461.27,"90th_percentile":2461.27,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":5388.83,"maximum":13639.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11208.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5496.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":7670.8},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12124.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":11603.9},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8764.64},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":8764.64},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":11603.9},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5388.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":9968.59},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":13639.73},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5496.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5442.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5442.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11295.29},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":5388.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11797.5},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8497.83},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":11797.5},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5442.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5658.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5604.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5442.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2800.0,"10th_percentile":2800.0,"90th_percentile":2800.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":11870.04,"maximum":32043.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24689.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12107.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18020.66},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26707.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":27260.53},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20590.37},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":20590.37},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":27260.53},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11870.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":23418.76},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":32043.21},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12107.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11988.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11988.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26535.53},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":11870.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":27715.35},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19963.58},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":27715.35},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11988.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12463.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12344.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11988.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":22999.0,"10th_percentile":22999.0,"90th_percentile":22999.0,"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":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":10357.28,"10th_percentile":594.12,"90th_percentile":11069.57,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11803.66,"10th_percentile":11803.66,"90th_percentile":11803.66,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20251.45,"10th_percentile":20251.45,"90th_percentile":20251.45,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":10523.89,"10th_percentile":10523.89,"90th_percentile":10523.89,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"11","median_amount":5334.46,"10th_percentile":552.84,"90th_percentile":10943.31,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_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":3604.02,"10th_percentile":3604.02,"90th_percentile":3604.02,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":3604.02,"10th_percentile":3604.02,"90th_percentile":3604.02,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":744.37,"10th_percentile":594.12,"90th_percentile":10864.02,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":10956.12,"10th_percentile":594.12,"90th_percentile":10970.16,"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."}]}]},{"description":"Cellulitis Without Mcc","code_information":[{"code":"603","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7500.01,"maximum":19634.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15600.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7650.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11042.14},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16875.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":16703.86},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12616.73},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":12616.73},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":16703.86},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7500.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":14349.82},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":19634.44},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7650.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7575.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7575.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16259.62},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":7500.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16982.55},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12232.66},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":16982.55},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7575.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7875.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7800.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7575.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":14121.68,"10th_percentile":1446.48,"90th_percentile":17501.65,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"1 through 10","median_amount":1857.34,"10th_percentile":1857.34,"90th_percentile":1857.34,"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] [MSDRG Base Rate: 102% of Medicare]","count":"32","median_amount":456.11,"10th_percentile":331.44,"90th_percentile":7113.33,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11167.66,"10th_percentile":11167.66,"90th_percentile":11167.66,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"1 through 10","median_amount":9372.66,"10th_percentile":9372.66,"90th_percentile":29277.25},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":14030.2,"10th_percentile":12082.3,"90th_percentile":19418.43},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":16495.09,"10th_percentile":16166.7,"90th_percentile":17285.45,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13308.3,"10th_percentile":12008.3,"90th_percentile":16064.91,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"20","median_amount":11905.0,"10th_percentile":6709.91,"90th_percentile":12140.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10064.34,"10th_percentile":10064.34,"90th_percentile":10064.34,"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":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":356.18,"10th_percentile":331.44,"90th_percentile":6680.64,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":13208.3,"10th_percentile":8558.3,"90th_percentile":15064.91,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":17838.69,"10th_percentile":9726.8,"90th_percentile":31995.78},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_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":331.44,"10th_percentile":331.44,"90th_percentile":331.44,"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":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"1 through 10","median_amount":2533.03,"10th_percentile":2533.03,"90th_percentile":2533.03,"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":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":356.18,"10th_percentile":356.18,"90th_percentile":356.18,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"35","median_amount":356.18,"10th_percentile":320.72,"90th_percentile":7039.26,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_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":1757.79,"10th_percentile":1757.79,"90th_percentile":1757.79,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":2302.75,"10th_percentile":1757.79,"90th_percentile":3107.95,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":1803.24,"10th_percentile":1803.24,"90th_percentile":3500.17,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15183.0,"10th_percentile":15183.0,"90th_percentile":16019.11,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11953.34,"10th_percentile":11953.34,"90th_percentile":11953.34,"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":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"30","median_amount":356.18,"10th_percentile":331.44,"90th_percentile":7039.82,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"19","median_amount":356.18,"10th_percentile":331.44,"90th_percentile":6743.42,"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."}]}]},{"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":12273.38,"maximum":33188.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25528.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12518.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18664.76},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27615.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12591.53,"10th_percentile":12591.53,"90th_percentile":12591.53,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":10998.05,"10th_percentile":10998.05,"90th_percentile":10998.05,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":11506.05,"10th_percentile":11506.05,"90th_percentile":11506.05,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":747.01,"10th_percentile":559.05,"90th_percentile":11053.74,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":7858.09,"maximum":20651.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16344.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8015.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11613.96},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17680.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":17568.88},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13270.09},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":13270.09},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":17568.88},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7858.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":15092.93},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":20651.22},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8015.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7936.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7936.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":16998.3,"10th_percentile":16998.3,"90th_percentile":16998.3,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12732.28,"10th_percentile":12732.28,"90th_percentile":12732.28,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":6847.17,"10th_percentile":373.53,"90th_percentile":6989.79,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":479.73,"10th_percentile":347.58,"90th_percentile":25197.73,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":4226.64,"10th_percentile":4226.64,"90th_percentile":4226.64,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"11","median_amount":479.73,"10th_percentile":347.58,"90th_percentile":7052.0,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":7035.02,"10th_percentile":7035.02,"90th_percentile":7035.02,"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."}]}]},{"description":"Minor Skin Disorders With Mcc","code_information":[{"code":"606","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12599.7,"maximum":34115.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26207.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12851.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19185.86},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28349.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":29023.18},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21921.73},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":21921.73},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":29023.18},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12599.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":24933.0},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":34115.09},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12851.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12725.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12725.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":28251.29},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":12599.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29507.4},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21254.41},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":29507.4},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12725.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13229.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13103.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12725.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":2337.31,"10th_percentile":2337.31,"90th_percentile":2337.31,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":605.93,"10th_percentile":605.93,"90th_percentile":605.93,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":7781.87,"maximum":20434.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16186.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7937.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11492.25},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17509.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":17384.75},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13131.02},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":13131.02},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":17384.75},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7781.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":14934.75},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":20434.79},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7937.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7859.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7859.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16922.4},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":7781.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17674.8},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12731.29},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":17674.8},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7859.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8170.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8093.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7859.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":13871.23,"10th_percentile":13871.23,"90th_percentile":13871.23,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":349.47,"10th_percentile":349.47,"90th_percentile":349.47,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13048.06,"10th_percentile":13048.06,"90th_percentile":13048.06,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1320.76,"10th_percentile":349.47,"90th_percentile":6588.7,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_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":1958.38,"10th_percentile":1958.38,"90th_percentile":1958.38,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":349.47,"10th_percentile":349.47,"90th_percentile":349.47,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":17987.61,"maximum":49414.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37414.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18347.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":27789.83},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40472.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":42038.72},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31752.61},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":31752.61},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":42038.72},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17987.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":36114.29},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":49414.13},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18347.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18167.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18167.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":40920.69},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":17987.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":42740.1},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30786.02},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":42740.1},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18167.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18886.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18707.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18167.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":16686.45,"10th_percentile":16686.45,"90th_percentile":16686.45,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":37261.11,"10th_percentile":37261.11,"90th_percentile":37261.11},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":15060.97,"10th_percentile":921.58,"90th_percentile":15350.97,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":921.58,"10th_percentile":857.56,"90th_percentile":16772.36,"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."}]}]},{"description":"Adrenal And Pituitary Procedures Without Cc/Mcc","code_information":[{"code":"615","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11695.37,"maximum":31547.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24326.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11929.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17741.72},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26314.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":26838.57},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20271.66},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":20271.66},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":26838.57},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11695.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":23056.27},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":31547.22},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11929.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11812.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11812.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26124.79},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":11695.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":27286.35},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19654.57},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":27286.35},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11812.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12280.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12163.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11812.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20955.38,"10th_percentile":20955.38,"90th_percentile":20955.38,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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","code_information":[{"code":"616","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28274.34,"maximum":78623.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":58810.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28839.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":44216.74},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":63617.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":66888.33},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":50521.96},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":50521.96},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":66888.33},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28274.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":57461.89},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":78623.43},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28839.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28557.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28557.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":65109.41},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":28274.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":68004.3},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48984.02},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":68004.3},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28557.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29688.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29405.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28557.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":28188.13,"10th_percentile":28188.13,"90th_percentile":28188.13,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1171.77,"10th_percentile":1171.77,"90th_percentile":1171.77,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":34746.55,"10th_percentile":34746.55,"90th_percentile":34746.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26625.17,"10th_percentile":26625.17,"90th_percentile":26625.17,"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":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":12308.53,"10th_percentile":726.84,"90th_percentile":209343.12,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29319.76,"10th_percentile":29319.76,"90th_percentile":29319.76,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":37075.3,"10th_percentile":37075.3,"90th_percentile":37075.3},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_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":726.84,"10th_percentile":726.84,"90th_percentile":726.84,"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":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"1 through 10","median_amount":8094.74,"10th_percentile":8094.74,"90th_percentile":8094.74,"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":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":14206.6,"10th_percentile":979.51,"90th_percentile":14429.18,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":91483.14,"10th_percentile":91483.14,"90th_percentile":91483.14},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":6107.7,"10th_percentile":6107.7,"90th_percentile":6107.7,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35130.01,"10th_percentile":35130.01,"90th_percentile":35130.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"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":11846.22,"maximum":31975.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24640.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12083.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17982.63},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26654.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":23510.49,"maximum":65096.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48901.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23980.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":36609.34},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52898.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":55380.33},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41829.76},{"payer_name":"Blue Cross","plan_name":"Health Options - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":13291.25,"maximum":36078.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27645.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13557.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":20290.2},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29905.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":30693.75},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23183.55},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":23183.55},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":30693.75},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13291.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":26368.14},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":36078.76},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13557.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13424.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13424.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29877.44},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":13291.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":31205.85},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22477.81},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":31205.85},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13424.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13955.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13822.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13424.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29127.68,"10th_percentile":29127.68,"90th_percentile":29127.68,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":11184.26,"10th_percentile":11184.26,"90th_percentile":11184.26,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":12561.59,"maximum":34006.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26128.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12812.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19125.0},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28263.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":28931.11},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21852.19},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":21852.19},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":28931.11},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12561.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":24853.91},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":34006.88},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12812.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12687.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12687.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":28844.41,"maximum":80242.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":59996.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29421.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":45127.1},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":64899.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":68265.46},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":51562.13},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":51562.13},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":68265.46},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28844.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":58644.94},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":80242.16},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29421.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29132.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29132.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":10584.81,"10th_percentile":10584.81,"90th_percentile":10584.81,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United 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15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care 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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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23986.97,"10th_percentile":23986.97,"90th_percentile":23986.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15387.11,"10th_percentile":15387.11,"90th_percentile":15387.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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","code_information":[{"code":"628","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30175.11,"maximum":84020.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62764.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30778.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":47252.1},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":67894.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":71480.02},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":53990.15},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":53990.15},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":71480.02},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30175.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":61406.48},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":84020.71},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30778.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30476.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30476.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":69578.98},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":30175.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":72672.6},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52346.63},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":72672.6},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30476.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31683.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31382.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30476.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":28349.69,"10th_percentile":28349.69,"90th_percentile":28349.69,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":71760.45,"10th_percentile":71760.45,"90th_percentile":71760.45,"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":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":28290.65,"10th_percentile":28290.65,"90th_percentile":28290.65,"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."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. 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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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31001.59,"10th_percentile":31001.59,"90th_percentile":31001.59,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":15333.95,"10th_percentile":15333.95,"90th_percentile":15333.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_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":11861.69,"10th_percentile":11861.69,"90th_percentile":11861.69,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":40904.38,"10th_percentile":40904.38,"90th_percentile":40904.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":764.37,"10th_percentile":764.37,"90th_percentile":764.37,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":11992.31,"maximum":32390.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24944.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12232.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18215.92},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26982.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":27555.91},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20813.47},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":20813.47},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":27555.91},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11992.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":23672.51},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":32390.4},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12232.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12112.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12112.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26823.05},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":11992.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":28015.65},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20179.89},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":28015.65},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12112.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12591.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12472.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12112.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":23440.35,"10th_percentile":23440.35,"90th_percentile":23440.35,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":547.99,"10th_percentile":547.99,"90th_percentile":18484.12,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":26361.36,"10th_percentile":26216.93,"90th_percentile":27966.13,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27759.92,"10th_percentile":27759.92,"90th_percentile":27759.92,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20073.64,"10th_percentile":18313.64,"90th_percentile":212288.5,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":8957.76,"10th_percentile":547.99,"90th_percentile":10792.88,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":44452.99,"10th_percentile":44452.99,"90th_percentile":44452.99},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1326.05,"10th_percentile":547.99,"90th_percentile":12236.78,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":3847.56,"10th_percentile":3847.56,"90th_percentile":7740.7,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26485.73,"10th_percentile":26485.73,"90th_percentile":26485.73,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19763.45,"10th_percentile":19763.45,"90th_percentile":19763.45,"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":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"14","median_amount":547.99,"10th_percentile":547.99,"90th_percentile":10879.89,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"1 through 10","median_amount":752.43,"10th_percentile":752.43,"90th_percentile":752.43,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":5624.07,"10th_percentile":588.89,"90th_percentile":10766.72,"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."}]}]},{"description":"Diabetes With Cc","code_information":[{"code":"638","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7700.88,"maximum":20204.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16017.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7854.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11362.92},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17326.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":17189.12},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12983.25},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":12983.25},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":17189.12},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7700.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":14766.69},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":20204.83},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7854.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7777.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7777.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16731.96},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":7700.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17475.9},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12588.03},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":17475.9},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7777.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8085.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8008.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7777.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":14677.06,"10th_percentile":14677.06,"90th_percentile":14677.06,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"1 through 10","median_amount":2607.23,"10th_percentile":2607.23,"90th_percentile":2607.23,"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":"Aetna","plan_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":469.36,"10th_percentile":345.13,"90th_percentile":7332.01,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10290.76,"10th_percentile":10290.76,"90th_percentile":10290.76,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":9995.24,"10th_percentile":9995.24,"90th_percentile":9995.24},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":16777.78,"10th_percentile":3831.07,"90th_percentile":17423.69,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14378.94,"10th_percentile":14378.94,"90th_percentile":17316.38,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"18","median_amount":10867.68,"10th_percentile":6015.0,"90th_percentile":12642.68,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":345.13,"10th_percentile":247.27,"90th_percentile":6910.8,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":12293.83,"10th_percentile":8707.12,"90th_percentile":16728.81,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":28392.72,"10th_percentile":28392.72,"90th_percentile":28392.72},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"1 through 10","median_amount":18144.11,"10th_percentile":18144.11,"90th_percentile":18144.11},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"1 through 10","median_amount":2033.61,"10th_percentile":2033.61,"90th_percentile":2033.61,"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":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"21","median_amount":490.33,"10th_percentile":345.13,"90th_percentile":7696.49,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":3831.07,"10th_percentile":3831.07,"90th_percentile":3831.07,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":3462.75,"10th_percentile":3350.95,"90th_percentile":3743.39,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16681.12,"10th_percentile":2800.0,"90th_percentile":16999.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6447.32,"10th_percentile":6447.32,"90th_percentile":6447.32,"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":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"23","median_amount":469.36,"10th_percentile":345.13,"90th_percentile":6984.31,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":6921.56,"10th_percentile":345.13,"90th_percentile":7016.36,"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."}]}]},{"description":"Diabetes Without Cc/Mcc","code_information":[{"code":"639","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5517.46,"maximum":14004.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11476.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5627.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":7876.19},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12414.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":11914.62},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8999.32},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":8999.32},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":11914.62},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5517.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":10235.51},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":14004.95},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5627.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5572.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5572.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11597.74},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":5517.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12113.4},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8725.38},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":12113.4},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5572.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5793.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5738.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5572.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":1531.44,"10th_percentile":1531.44,"90th_percentile":1531.44,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"1 through 10","median_amount":3363.18,"10th_percentile":3363.18,"90th_percentile":3363.18,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7944.66,"10th_percentile":7944.66,"90th_percentile":7944.66,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":15911.49,"10th_percentile":15911.49,"90th_percentile":15911.49},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":12772.1,"10th_percentile":12772.1,"90th_percentile":12772.1,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6862.05,"10th_percentile":6862.05,"90th_percentile":6862.05,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":4797.6,"10th_percentile":4797.6,"90th_percentile":4797.6,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9223.21,"10th_percentile":9223.21,"90th_percentile":9223.21,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":5200.1,"10th_percentile":5200.1,"90th_percentile":5200.1,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":2148.17,"10th_percentile":2148.17,"90th_percentile":2148.17,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":3265.23,"10th_percentile":3265.23,"90th_percentile":3265.23,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12113.4,"10th_percentile":12113.4,"90th_percentile":12113.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":253.38,"10th_percentile":235.78,"90th_percentile":7142.01,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":4914.8,"10th_percentile":4914.8,"90th_percentile":4914.8,"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."}]}]},{"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":11189.61,"maximum":30111.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23274.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11413.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16934.07},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25176.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":25616.81},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19348.84},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":19348.84},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":25616.81},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11189.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":22006.68},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":30111.1},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11413.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11301.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11301.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":26252.17,"10th_percentile":26252.17,"90th_percentile":26252.17,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21090.96,"10th_percentile":21090.96,"90th_percentile":23572.13,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18305.15,"10th_percentile":18305.15,"90th_percentile":18305.15,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"14","median_amount":1256.2,"10th_percentile":499.71,"90th_percentile":10431.38,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14812.7,"10th_percentile":14812.7,"90th_percentile":14812.7,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"41","median_amount":537.01,"10th_percentile":499.71,"90th_percentile":10029.01,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":24135.71,"10th_percentile":24135.71,"90th_percentile":24135.71},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":3552.57,"10th_percentile":3552.57,"90th_percentile":3552.57,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":3888.21,"10th_percentile":3888.21,"90th_percentile":3888.21,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25088.0,"10th_percentile":25088.0,"90th_percentile":25088.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"50","median_amount":582.87,"10th_percentile":416.4,"90th_percentile":10133.35,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"1 through 10","median_amount":10804.54,"10th_percentile":10804.54,"90th_percentile":10804.54,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"13","median_amount":699.48,"10th_percentile":416.4,"90th_percentile":9958.68,"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":"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":6763.99,"maximum":17544.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14069.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6899.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9866.8},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15218.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":14925.88},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11273.78},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":11273.78},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":14925.88},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6763.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":12822.4},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":17544.52},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6899.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6831.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6831.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14528.92},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":6763.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15174.9},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10930.6},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":15174.9},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6831.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7102.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7034.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6831.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":1011.6,"10th_percentile":1011.6,"90th_percentile":1011.6,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"16","median_amount":315.98,"10th_percentile":294.03,"90th_percentile":6068.4,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9907.37,"10th_percentile":9907.37,"90th_percentile":9907.37,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":13777.83,"10th_percentile":13777.83,"90th_percentile":16677.34},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":14437.49,"10th_percentile":14437.49,"90th_percentile":14437.49,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13188.3,"10th_percentile":13188.3,"90th_percentile":13188.3,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10676.59,"10th_percentile":7770.82,"90th_percentile":10770.82,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":644.03,"10th_percentile":243.05,"90th_percentile":5718.29,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11455.14,"10th_percentile":11455.14,"90th_percentile":11455.14,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":8358.6,"10th_percentile":8358.6,"90th_percentile":8358.6},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_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":294.03,"10th_percentile":294.03,"90th_percentile":294.03,"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":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"1 through 10","median_amount":3802.71,"10th_percentile":3802.71,"90th_percentile":3802.71,"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":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"36","median_amount":407.56,"10th_percentile":294.03,"90th_percentile":6367.85,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":9989.88,"10th_percentile":9989.88,"90th_percentile":9989.88},{"payer_name":"Molina","plan_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":1524.14,"10th_percentile":1524.14,"90th_percentile":1524.14,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":1524.14,"10th_percentile":1524.14,"90th_percentile":1524.14,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":3092.02,"10th_percentile":1524.14,"90th_percentile":3641.14,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2597.0,"10th_percentile":2597.0,"90th_percentile":2597.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"1 through 10","median_amount":315.98,"10th_percentile":315.98,"90th_percentile":6015.89,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":315.98,"10th_percentile":294.03,"90th_percentile":6028.41,"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."}]}]},{"description":"Inborn And Other Disorders Of Metabolism","code_information":[{"code":"642","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11876.39,"maximum":32061.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24702.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12113.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18030.81},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26721.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23605.44,"10th_percentile":23605.44,"90th_percentile":23605.44,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":9619.81,"10th_percentile":9619.81,"90th_percentile":9619.81,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":13654.89,"maximum":37111.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28402.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13927.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":20870.9},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30723.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":31572.2},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23847.05},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":23847.05},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":31572.2},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13654.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":27122.79},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":37111.32},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13927.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13791.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13791.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":30732.52},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":13654.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":32098.95},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23121.12},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":32098.95},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13791.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14337.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14201.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13791.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":12567.58,"10th_percentile":862.1,"90th_percentile":12928.27,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":10252.67,"10th_percentile":623.61,"90th_percentile":12266.01,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25943.71,"10th_percentile":25943.71,"90th_percentile":25943.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":10965.82,"10th_percentile":1686.0,"90th_percentile":12322.91,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":623.61,"10th_percentile":350.0,"90th_percentile":12846.56,"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."}]}]},{"description":"Endocrine Disorders With Cc","code_information":[{"code":"644","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8723.52,"maximum":23108.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18144.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8897.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12995.98},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19627.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":19659.5},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14849.18},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":14849.18},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":19659.5},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8723.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":16888.93},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":23108.63},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8897.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8810.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8810.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19136.65},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":8723.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19987.5},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14397.15},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":19987.5},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8810.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9159.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9072.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8810.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":11858.06,"10th_percentile":11858.06,"90th_percentile":11858.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16585.29,"10th_percentile":16585.29,"90th_percentile":16585.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14580.61,"10th_percentile":14580.61,"90th_percentile":14580.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"1 through 10","median_amount":17393.31,"10th_percentile":17393.31,"90th_percentile":17393.31},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":7731.48,"10th_percentile":417.88,"90th_percentile":7800.5,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18794.45,"10th_percentile":18794.45,"90th_percentile":20151.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":14940.61,"10th_percentile":14940.61,"90th_percentile":14940.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4733.6,"10th_percentile":4733.6,"90th_percentile":4733.6,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11707.68,"10th_percentile":11707.68,"90th_percentile":11707.68,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":2173.7,"10th_percentile":2173.7,"90th_percentile":2173.7,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":4943.26,"10th_percentile":4943.26,"90th_percentile":4943.26,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":6006.51,"10th_percentile":6006.51,"90th_percentile":6006.51,"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."}]}]},{"description":"Kidney Transplant With Hemodialysis With Mcc","code_information":[{"code":"650","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37913.18,"maximum":105993.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":78859.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38671.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":59609.05},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":85304.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":90172.85},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":68109.18},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":68109.18},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":90172.85},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37913.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":77464.97},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":105993.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38671.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38292.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38292.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":87774.67},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":37913.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":91677.3},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":66035.86},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":91677.3},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38292.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39808.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39429.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38292.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":30008.37,"maximum":83547.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62417.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30608.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":46985.84},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":67518.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":41843.35,"maximum":117152.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":87034.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42680.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":65885.16},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":94147.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":99666.95},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":75280.25},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":75280.25},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":99666.95},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41843.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":85621.08},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":117152.84},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42680.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42261.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42261.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":97016.27},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":41843.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":101329.8},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":72988.63},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":101329.8},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42261.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43935.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43517.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42261.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":31526.76,"10th_percentile":31526.76,"90th_percentile":31526.76,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":22811.0,"maximum":63110.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":47446.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23267.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":35492.32},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":51324.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":53690.57},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40553.46},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":40553.46},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":53690.57},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22811.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":46124.07},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":63110.22},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23267.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23039.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23039.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":52262.65},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":22811.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":54586.35},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39318.97},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":54586.35},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23039.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23951.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23723.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23039.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":42135.96,"10th_percentile":42135.96,"90th_percentile":42135.96,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":39318.97,"10th_percentile":39318.97,"90th_percentile":39318.97,"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":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":17390.54,"maximum":47718.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36172.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17738.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":26836.37},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39128.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":40596.39},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30663.18},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":30663.18},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":40596.39},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17390.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":34875.22},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":47718.75},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17738.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17564.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17564.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":39516.71},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":17390.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":41273.7},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29729.76},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":41273.7},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17564.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18260.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18086.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17564.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":25863.83,"maximum":71778.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":53796.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26381.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":40367.4},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":58193.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":61065.28},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":46123.71},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":46123.71},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":61065.28},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25863.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":52459.47},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":71778.77},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26381.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26122.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26122.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":59441.23},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":25863.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":62084.1},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44719.65},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":62084.1},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26122.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27157.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26898.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26122.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":12017.6,"10th_percentile":12017.6,"90th_percentile":12017.6,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":15115.01,"maximum":41257.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31439.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15417.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":23202.57},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34008.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":13281.91,"10th_percentile":13281.91,"90th_percentile":13281.91,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27419.15,"10th_percentile":27419.15,"90th_percentile":27419.15,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":14116.22,"10th_percentile":14116.22,"90th_percentile":14116.22,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35685.0,"10th_percentile":35685.0,"90th_percentile":35685.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23323.26,"10th_percentile":23323.26,"90th_percentile":23323.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":13528.14,"10th_percentile":13528.14,"90th_percentile":13528.14,"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":"Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc","code_information":[{"code":"658","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12906.18,"maximum":34985.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26844.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13164.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19675.27},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29038.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":29763.52},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22480.93},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":22480.93},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":29763.52},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12906.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":25569.01},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":34985.33},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13164.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13035.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13035.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":28971.95},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":12906.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":30260.1},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21796.58},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":30260.1},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13035.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13551.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13422.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13035.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":23534.18,"10th_percentile":23534.18,"90th_percentile":23842.01,"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":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":608.19,"10th_percentile":608.19,"90th_percentile":608.19,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":29479.48,"10th_percentile":29479.48,"90th_percentile":29479.48,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20131.14,"10th_percentile":20131.14,"90th_percentile":20131.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":57620.33,"10th_percentile":57620.33,"90th_percentile":57620.33},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":3557.14,"10th_percentile":608.19,"90th_percentile":11196.3,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19204.03,"10th_percentile":19204.03,"90th_percentile":19204.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":11088.61,"10th_percentile":565.93,"90th_percentile":11198.17,"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."}]}]},{"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":20759.37,"maximum":57284.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43179.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21174.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":32216.07},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":46708.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":48734.46},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36810.02},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":36810.02},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":48734.46},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20759.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":41866.41},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":57284.59},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21174.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20966.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20966.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":47438.35},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":20759.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":49547.55},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35689.48},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":49547.55},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20966.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21797.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21589.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20966.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":22116.62,"10th_percentile":22116.62,"90th_percentile":22116.62,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":18980.78,"10th_percentile":1045.03,"90th_percentile":21045.88,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"1 through 10","median_amount":57138.21,"10th_percentile":57138.21,"90th_percentile":57138.21},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":46716.37,"10th_percentile":46716.37,"90th_percentile":46716.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":9888.68,"10th_percentile":1045.03,"90th_percentile":19144.88,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":18976.66,"10th_percentile":18976.66,"90th_percentile":18976.66,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":11079.24,"maximum":29797.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23044.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11300.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16757.83},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24928.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":25350.21},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19147.47},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":19147.47},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":25350.21},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11079.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":21777.65},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":29797.73},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11300.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11190.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11190.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":11411.23,"10th_percentile":541.87,"90th_percentile":12879.44,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"1 through 10","median_amount":22814.34,"10th_percentile":22814.34,"90th_percentile":22814.34},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":29559.67,"10th_percentile":29559.67,"90th_percentile":29559.67},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":24155.15,"10th_percentile":24155.15,"90th_percentile":24155.15,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25537.89,"10th_percentile":25537.89,"90th_percentile":25537.89,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18470.56,"10th_percentile":18470.56,"90th_percentile":18470.56,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":8798.16,"10th_percentile":504.22,"90th_percentile":40697.5,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19207.18,"10th_percentile":18462.57,"90th_percentile":50467.5,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":29893.03,"10th_percentile":29893.03,"90th_percentile":29893.03},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"1 through 10","median_amount":4418.35,"10th_percentile":4418.35,"90th_percentile":4418.35,"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":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"20","median_amount":692.2,"10th_percentile":504.22,"90th_percentile":10367.15,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":3420.33,"10th_percentile":3420.33,"90th_percentile":3420.33,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16378.57,"10th_percentile":16378.57,"90th_percentile":24370.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"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":8806.1,"maximum":23343.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18316.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8982.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13127.84},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19813.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8858.53,"10th_percentile":8858.53,"90th_percentile":8858.53,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12875.65,"10th_percentile":12875.65,"90th_percentile":12875.65,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17724.16,"10th_percentile":17724.16,"90th_percentile":17724.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13931.99,"10th_percentile":13931.99,"90th_percentile":13931.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Minor Bladder Procedures With Mcc","code_information":[{"code":"662","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24892.8,"maximum":69021.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":51777.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25390.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":38816.76},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":56008.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":12655.28,"maximum":34272.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26322.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12908.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19274.62},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28474.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":29157.44},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22023.14},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":22023.14},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":29157.44},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12655.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":25048.34},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":34272.91},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12908.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12781.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12781.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":28381.98},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":12655.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29643.9},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21352.73},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":29643.9},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12781.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13288.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13161.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12781.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":11362.39,"10th_percentile":11362.39,"90th_percentile":11397.39,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_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":4830.88,"10th_percentile":4830.88,"90th_percentile":4830.88,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":8897.4,"maximum":23602.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18506.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9075.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13273.65},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20019.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":20079.54},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15166.44},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":15166.44},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":20079.54},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8897.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":17249.77},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":23602.36},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9075.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8986.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8986.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":25366.8,"maximum":70367.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52762.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25874.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":39573.69},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":57075.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":14474.28,"maximum":39437.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30106.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14763.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22179.37},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32567.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":33551.57},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25342.11},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":25342.11},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":33551.57},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14474.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":28823.22},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":39437.97},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14763.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14619.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14619.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":32659.26},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":14474.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":34111.35},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24570.67},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":34111.35},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14619.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15197.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15053.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14619.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":250.0,"10th_percentile":250.0,"90th_percentile":250.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":13579.36,"10th_percentile":13579.36,"90th_percentile":13579.36,"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."}]}]},{"description":"Prostatectomy Without Cc/Mcc","code_information":[{"code":"667","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9368.23,"maximum":24939.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19485.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9555.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14025.51},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21078.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":21216.92},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16025.52},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":16025.52},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":21216.92},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9368.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":18226.86},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":24939.28},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9555.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9461.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9461.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20652.64},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":9368.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21570.9},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15537.69},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":21570.9},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9461.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9836.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9742.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9461.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":23769.33,"maximum":65831.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":49440.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24244.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":37022.68},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":53480.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":56005.6},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42302.04},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":42302.04},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":56005.6},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23769.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":48112.84},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":65831.4},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24244.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24007.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24007.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":54516.11},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":23769.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":56940.0},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41014.32},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":56940.0},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24007.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24957.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24720.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24007.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":21310.15,"10th_percentile":1097.36,"90th_percentile":22975.74,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":12907.76,"maximum":34989.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26848.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13165.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19677.81},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29042.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":29767.36},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22483.82},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":22483.82},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":29767.36},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12907.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":25572.3},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":34989.84},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13165.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13036.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13036.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":28975.68},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":12907.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":30264.0},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21799.39},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":30264.0},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13036.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13553.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13424.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13036.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":625.78,"10th_percentile":625.78,"90th_percentile":625.78,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":11465.05,"10th_percentile":11465.05,"90th_percentile":11465.05,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":8344.8,"maximum":22033.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17357.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8511.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12391.19},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18775.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":18744.61},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14158.15},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":14158.15},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":18744.61},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8344.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":16102.97},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":22033.23},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8511.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8428.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8428.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18246.09},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":8344.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19057.35},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13727.16},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":19057.35},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8428.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8762.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8678.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8428.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":359.61,"10th_percentile":359.61,"90th_percentile":359.61,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":14837.12,"maximum":40468.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30861.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15133.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22758.81},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33383.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":34428.1},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26004.17},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":26004.17},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":34428.1},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14837.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":29576.22},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":40468.28},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15133.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14985.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14985.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":33512.47},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":14837.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":35002.5},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25212.57},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":35002.5},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14985.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15578.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15430.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14985.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":14373.43,"10th_percentile":14373.43,"90th_percentile":14373.43,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":12707.27,"10th_percentile":12707.27,"90th_percentile":12707.27,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":9156.24,"maximum":24337.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19044.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9339.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13686.98},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20601.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":20704.81},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15638.72},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":15638.72},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":20704.81},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9156.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":17786.92},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":24337.33},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9339.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9247.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9247.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20154.16},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":9156.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21050.25},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15162.66},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":21050.25},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9247.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9614.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9522.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9247.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":33944.9,"maximum":94725.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":70605.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34623.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":53272.09},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":76376.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":80586.69},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":60868.58},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":60868.58},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":80586.69},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33944.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":69229.76},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":94725.07},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34623.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34284.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34284.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":78443.45},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":33944.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":81931.2},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":59015.67},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":81931.2},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34284.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35642.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35302.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34284.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":4072.0,"10th_percentile":1576.49,"90th_percentile":33334.81,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":60393.47,"10th_percentile":60393.47,"90th_percentile":60393.47,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":61318.15,"10th_percentile":61318.15,"90th_percentile":61318.15,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":65080.36,"10th_percentile":65080.36,"90th_percentile":65080.36,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":30352.1,"10th_percentile":30352.1,"90th_percentile":30352.1,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":29241.16,"10th_percentile":1694.18,"90th_percentile":30180.28,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"1 through 10","median_amount":29550.47,"10th_percentile":29550.47,"90th_percentile":29550.47,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":19153.16,"maximum":52723.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39838.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19536.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":29651.11},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43094.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31818.99,"10th_percentile":31818.99,"90th_percentile":31818.99,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":37171.32,"10th_percentile":37171.32,"90th_percentile":37171.32,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"1 through 10","median_amount":57543.56,"10th_percentile":57543.56,"90th_percentile":57543.56},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":16969.43,"10th_percentile":16969.43,"90th_percentile":16969.43,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":16940.29,"10th_percentile":868.61,"90th_percentile":19444.6,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3030.93,"10th_percentile":3030.93,"90th_percentile":3030.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1224.77,"10th_percentile":868.61,"90th_percentile":18262.94,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"1 through 10","median_amount":17453.21,"10th_percentile":17453.21,"90th_percentile":17453.21,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1050.0,"10th_percentile":933.47,"90th_percentile":16997.86,"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."}]}]},{"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":13617.58,"maximum":37005.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28324.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13889.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":20811.31},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30639.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":12344.04,"maximum":33389.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25675.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12590.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18777.6},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27774.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":28405.58},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21455.25},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":21455.25},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":28405.58},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12344.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":24402.44},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":33389.15},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12590.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12467.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12467.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":27650.12},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":12344.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":28879.5},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20802.13},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":28879.5},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12467.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12961.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12837.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12467.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"11","median_amount":607.34,"10th_percentile":565.15,"90th_percentile":11686.68,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":32277.16,"10th_percentile":32277.16,"90th_percentile":32277.16},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":16508.81,"10th_percentile":16508.81,"90th_percentile":16508.81,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26178.42,"10th_percentile":26178.42,"90th_percentile":26178.42,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20702.19,"10th_percentile":16976.62,"90th_percentile":20702.19,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":8200.66,"10th_percentile":565.15,"90th_percentile":10524.92,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24583.12,"10th_percentile":24583.12,"90th_percentile":24583.12,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":34691.34,"10th_percentile":34691.34,"90th_percentile":34691.34},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"17","median_amount":607.34,"10th_percentile":312.86,"90th_percentile":11294.75,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":4018.12,"10th_percentile":4018.12,"90th_percentile":4018.12,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17333.55,"10th_percentile":17333.55,"90th_percentile":17333.55,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20802.13,"10th_percentile":20802.13,"90th_percentile":20802.13,"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":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"19","median_amount":607.34,"10th_percentile":565.15,"90th_percentile":11186.3,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"1 through 10","median_amount":11498.06,"10th_percentile":11498.06,"90th_percentile":11498.06,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":565.15,"10th_percentile":565.15,"90th_percentile":700.0,"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":"Renal Failure With Cc","code_information":[{"code":"683","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7538.91,"maximum":19744.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15680.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7689.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11104.27},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16962.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":16797.84},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12687.71},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":12687.71},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":16797.84},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7538.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":14430.56},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":19744.91},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7689.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7614.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7614.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16351.1},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":7538.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17078.1},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12301.49},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":17078.1},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7614.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7915.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7840.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7614.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":1446.48,"10th_percentile":1446.48,"90th_percentile":1446.48,"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":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"20","median_amount":950.0,"10th_percentile":334.48,"90th_percentile":6880.09,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":7895.65,"10th_percentile":7895.65,"90th_percentile":7895.65},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":17255.9,"10th_percentile":17255.9,"90th_percentile":17255.9,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15862.65,"10th_percentile":15862.65,"90th_percentile":16212.65,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12781.43,"10th_percentile":12781.43,"90th_percentile":12781.43,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":334.48,"10th_percentile":334.48,"90th_percentile":6478.46,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14537.4,"10th_percentile":14537.4,"90th_percentile":14537.4,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":22609.11,"10th_percentile":13478.77,"90th_percentile":30586.66},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_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":334.48,"10th_percentile":334.48,"90th_percentile":334.48,"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":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":7087.78,"10th_percentile":7087.78,"90th_percentile":7087.78,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"24","median_amount":550.0,"10th_percentile":334.48,"90th_percentile":7471.26,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":23913.49,"10th_percentile":23913.49,"90th_percentile":23913.49},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17078.1,"10th_percentile":17078.1,"90th_percentile":26537.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12063.26,"10th_percentile":12063.26,"90th_percentile":12063.26,"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":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"45","median_amount":359.45,"10th_percentile":334.48,"90th_percentile":6793.78,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"1 through 10","median_amount":359.45,"10th_percentile":359.45,"90th_percentile":359.45,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"23","median_amount":359.45,"10th_percentile":334.48,"90th_percentile":6793.99,"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."}]}]},{"description":"Renal Failure Without Cc/Mcc","code_information":[{"code":"684","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5351.52,"maximum":13533.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11131.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5458.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":7611.2},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12040.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":11513.75},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8696.55},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":8696.55},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":11513.75},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5351.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":9891.14},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":13533.76},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5458.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5405.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5405.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11207.54},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":5351.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11705.85},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8431.81},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":11705.85},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5405.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5619.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5565.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5405.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":723.24,"10th_percentile":723.24,"90th_percentile":723.24,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":4817.53,"10th_percentile":4817.53,"90th_percentile":4817.53,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7717.39,"10th_percentile":7717.39,"90th_percentile":7717.39,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8372.4,"10th_percentile":8372.4,"90th_percentile":8372.4,"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":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1188.27,"10th_percentile":228.56,"90th_percentile":4759.03,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":245.62,"10th_percentile":228.56,"90th_percentile":4799.16,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"1 through 10","median_amount":5040.98,"10th_percentile":5040.98,"90th_percentile":5040.98,"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] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":14906.2,"maximum":40664.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31004.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15204.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22869.11},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33538.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":34594.97},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26130.2},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":26130.2},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":34594.97},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14906.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":29719.56},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":40664.42},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15204.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15055.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15055.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":33674.9},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":14906.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":35172.15},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25334.77},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":35172.15},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15055.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15651.51,"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"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15055.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":33631.49,"10th_percentile":33631.49,"90th_percentile":33631.49,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":11147.21,"10th_percentile":11147.21,"90th_percentile":11147.21,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":8904.55,"maximum":23622.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18521.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9082.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13285.06},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20035.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":20096.8},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15179.48},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":15179.48},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":20096.8},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8904.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":17264.6},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":23622.65},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9082.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8993.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8993.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19562.32},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":8904.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20432.1},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14717.4},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":20432.1},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8993.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9349.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9260.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8993.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":396.12,"10th_percentile":396.12,"90th_percentile":396.12,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":6860.07,"maximum":17817.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14268.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6997.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10020.21},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15435.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":15157.95},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11449.08},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":11449.08},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":15157.95},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6860.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":13021.77},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":17817.31},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6997.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6928.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6928.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":9797.77,"maximum":26158.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20379.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9993.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14711.44},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22044.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"28","median_amount":593.0,"10th_percentile":440.36,"90th_percentile":9282.7,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10176.17,"10th_percentile":10176.17,"90th_percentile":10176.17,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":21664.22,"10th_percentile":21664.22,"90th_percentile":21664.22,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16131.42,"10th_percentile":16131.42,"90th_percentile":34856.45,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"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":607.67,"10th_percentile":440.36,"90th_percentile":8662.17,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13217.5,"10th_percentile":13217.5,"90th_percentile":15900.98,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_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":607.67,"10th_percentile":607.67,"90th_percentile":607.67,"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":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"1 through 10","median_amount":3762.36,"10th_percentile":3762.36,"90th_percentile":3762.36,"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":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":9191.68,"10th_percentile":9191.68,"90th_percentile":9191.68,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"40","median_amount":607.67,"10th_percentile":440.36,"90th_percentile":9409.56,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":3177.69,"10th_percentile":3177.69,"90th_percentile":3177.69,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"53","median_amount":440.36,"10th_percentile":276.81,"90th_percentile":8798.48,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"1 through 10","median_amount":9059.83,"10th_percentile":9059.83,"90th_percentile":9059.83,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":8819.48,"10th_percentile":440.36,"90th_percentile":9223.28,"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":"Kidney And Urinary Tract Infections Without Mcc","code_information":[{"code":"690","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7012.51,"maximum":18250.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14586.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7152.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10263.65},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15778.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":15526.21},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11727.23},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":11727.23},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":15526.21},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7012.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":13338.13},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":18250.18},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7152.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7082.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7082.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15113.28},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":7012.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15785.25},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11370.24},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":15785.25},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7082.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7363.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7293.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7082.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":1791.59,"10th_percentile":1791.59,"90th_percentile":1791.59,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"32","median_amount":324.56,"10th_percentile":302.01,"90th_percentile":6478.52,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10176.17,"10th_percentile":10176.17,"90th_percentile":10176.17,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"1 through 10","median_amount":13678.04,"10th_percentile":13678.04,"90th_percentile":13678.04},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":9727.74,"10th_percentile":7132.64,"90th_percentile":23179.76},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"11","median_amount":14940.27,"10th_percentile":14910.55,"90th_percentile":16289.03,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14288.62,"10th_percentile":14288.62,"90th_percentile":14288.62,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":10563.04,"10th_percentile":9044.95,"90th_percentile":11813.84,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"14","median_amount":302.01,"10th_percentile":302.01,"90th_percentile":5847.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11963.55,"10th_percentile":8877.55,"90th_percentile":12582.36,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":33522.01,"10th_percentile":27619.44,"90th_percentile":62628.0},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_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":324.56,"10th_percentile":324.56,"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":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":6158.59,"10th_percentile":302.01,"90th_percentile":6161.19,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"62","median_amount":324.56,"10th_percentile":302.01,"90th_percentile":6175.5,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":3476.68,"10th_percentile":3476.68,"90th_percentile":3476.68,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":1951.29,"10th_percentile":1935.73,"90th_percentile":3476.68,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":302.01,"10th_percentile":302.01,"90th_percentile":302.01,"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":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15650.7,"10th_percentile":15650.7,"90th_percentile":35726.03,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"79","median_amount":334.54,"10th_percentile":280.72,"90th_percentile":6210.2,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"1 through 10","median_amount":324.56,"10th_percentile":324.56,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"23","median_amount":324.56,"10th_percentile":302.01,"90th_percentile":6203.19,"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":"Urinary Stones With Mcc","code_information":[{"code":"693","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11260.27,"maximum":30311.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23421.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11485.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17046.92},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25335.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":25787.51},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19477.77},{"payer_name":"Blue Cross","plan_name":"Health Options - 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Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25101.68},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":11260.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26217.75},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18884.85},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":26217.75},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11372.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11823.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11710.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11372.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23302.0,"10th_percentile":23302.0,"90th_percentile":23302.0,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26818.63,"10th_percentile":26818.63,"90th_percentile":26818.63,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":9467.3,"10th_percentile":9467.3,"90th_percentile":9467.3,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":594.6,"10th_percentile":594.6,"90th_percentile":594.6,"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."}]}]},{"description":"Urinary Stones Without Mcc","code_information":[{"code":"694","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6791.78,"maximum":17623.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14126.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6927.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9911.17},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15281.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":14993.01},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11324.49},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":11324.49},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":14993.01},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6791.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":12880.07},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":17623.43},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6927.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6859.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6859.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14594.26},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":6791.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15243.15},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10979.76},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":15243.15},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6859.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7131.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7063.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6859.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":294.03,"10th_percentile":294.03,"90th_percentile":294.03,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14251.95,"10th_percentile":14251.95,"90th_percentile":14251.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4770.82,"10th_percentile":4770.82,"90th_percentile":4770.82,"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":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":409.39,"10th_percentile":409.39,"90th_percentile":5533.7,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":16958.58,"10th_percentile":16958.58,"90th_percentile":16958.58},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":3430.1,"10th_percentile":315.98,"90th_percentile":6069.37,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":315.98,"10th_percentile":315.98,"90th_percentile":6038.6,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":6383.81,"10th_percentile":6383.81,"90th_percentile":6383.81,"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":"Kidney And Urinary Tract Signs And Symptoms With Mcc","code_information":[{"code":"695","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9666.76,"maximum":25786.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20106.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9860.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14502.24},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21750.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":21938.08},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16570.23},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":16570.23},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":21938.08},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9666.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":18846.39},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":25786.97},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9860.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9763.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9763.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":6055.77,"maximum":15533.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12596.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6176.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8735.83},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13625.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12863.56},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":6055.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13435.5},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9677.69},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":13435.5},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6116.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6358.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6298.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6116.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":4769.56,"10th_percentile":4769.56,"90th_percentile":4769.56,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13435.91,"10th_percentile":13435.91,"90th_percentile":13435.91,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9272.05,"10th_percentile":9272.05,"90th_percentile":9272.05,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":279.75,"10th_percentile":260.32,"90th_percentile":5370.59,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":9142.74,"maximum":24299.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19016.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9325.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13665.43},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20571.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":20672.2},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15614.09},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":15614.09},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":20672.2},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9142.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":17758.91},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":24299.0},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9325.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9234.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9234.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20122.42},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":9142.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21017.1},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15138.78},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":21017.1},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9234.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9599.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9508.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9234.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":7544.28,"10th_percentile":7544.28,"90th_percentile":7544.28,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":13720.79,"maximum":37298.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28539.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13995.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":20976.14},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30871.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":30003.41,"10th_percentile":30003.41,"90th_percentile":39273.08,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26351.47,"10th_percentile":26351.47,"90th_percentile":26351.47,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23169.53,"10th_percentile":21773.92,"90th_percentile":23169.53,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":10666.28,"10th_percentile":10666.28,"90th_percentile":12269.56,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26351.47,"10th_percentile":26351.47,"90th_percentile":26351.47,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":29995.0,"10th_percentile":29995.0,"90th_percentile":29995.0},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":12489.68,"10th_percentile":12489.68,"90th_percentile":12489.68,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"51","median_amount":866.45,"10th_percentile":632.5,"90th_percentile":12839.67,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":4395.98,"10th_percentile":4227.44,"90th_percentile":9077.26,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"46","median_amount":679.72,"10th_percentile":566.41,"90th_percentile":12505.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses With Cc","code_information":[{"code":"699","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8644.13,"maximum":22883.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17979.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8817.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12869.19},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19449.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":19467.7},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14704.31},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":14704.31},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":19467.7},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8644.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":16724.16},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":22883.18},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8817.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8730.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8730.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18949.95},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":8644.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19792.5},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14256.69},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":19792.5},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8730.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9076.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8989.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8730.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"14","median_amount":1950.0,"10th_percentile":383.78,"90th_percentile":7831.43,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":16446.6,"10th_percentile":16446.6,"90th_percentile":16446.6},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":19890.11,"10th_percentile":19747.06,"90th_percentile":20116.96,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14058.3,"10th_percentile":14058.3,"90th_percentile":14058.3,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"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":6048.23,"10th_percentile":383.78,"90th_percentile":7673.46,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18601.96,"10th_percentile":18601.96,"90th_percentile":18601.96,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":48021.53,"10th_percentile":48021.53,"90th_percentile":48021.53},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"30","median_amount":531.58,"10th_percentile":239.85,"90th_percentile":8097.61,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":2455.52,"10th_percentile":2455.52,"90th_percentile":2455.52,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":4395.98,"10th_percentile":4395.98,"90th_percentile":4395.98,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13841.06,"10th_percentile":13841.06,"90th_percentile":13841.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1566.95,"10th_percentile":359.79,"90th_percentile":7713.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":5708.03,"10th_percentile":5708.03,"90th_percentile":5708.03,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2800.0,"10th_percentile":2800.0,"90th_percentile":2800.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":261.22,"10th_percentile":261.22,"90th_percentile":7606.33,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":16467.15,"maximum":45096.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34251.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16796.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":25361.8},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37051.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":38365.75},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28978.35},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":28978.35},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":38365.75},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16467.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":32958.94},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":45096.76},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16796.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16631.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16631.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":37345.4},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":16467.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":39005.85},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28096.21},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":39005.85},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16631.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17290.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17125.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16631.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":14612.49,"10th_percentile":14612.49,"90th_percentile":14612.49,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":12766.44,"maximum":34588.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26554.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13021.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19452.12},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28724.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":29425.96},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22225.96},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":22225.96},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":29425.96},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12766.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":25279.01},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":34588.54},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13021.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12894.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12894.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":28643.36},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":12766.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29916.9},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21549.37},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":29916.9},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12894.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13404.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13277.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12894.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":19061.86,"maximum":52464.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39648.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19443.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":29505.3},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42889.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":44633.78},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33712.7},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":33712.7},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":44633.78},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19061.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":38343.63},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":52464.47},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19443.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19252.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19252.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":43446.72},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":19061.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":45378.45},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32686.45},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":45378.45},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19252.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20014.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19824.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19252.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":11710.45,"maximum":31590.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24357.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11944.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17765.81},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26348.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":17130.12,"maximum":46979.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35630.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17472.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":26420.5},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38542.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":39967.28},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30188.01},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":30188.01},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":39967.28},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17130.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":34334.77},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":46979.27},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17472.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17301.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17301.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":38904.34},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":17130.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":40634.1},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29269.05},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":40634.1},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17301.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17986.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17815.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17301.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":34276.91,"10th_percentile":34276.91,"90th_percentile":34276.91,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":9316.62,"maximum":24792.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19378.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9502.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13943.1},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20962.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":21092.25},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15931.35},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":15931.35},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":21092.25},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9316.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":18119.76},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":24792.74},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9502.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9409.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9409.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20531.29},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":9316.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21444.15},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15446.39},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":21444.15},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9409.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9782.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9689.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9409.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":12521.89,"maximum":33894.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26045.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12772.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19061.61},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28174.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":10593.92,"10th_percentile":10593.92,"90th_percentile":10593.92,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":10757.22,"10th_percentile":10757.22,"90th_percentile":10757.22,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":2672.0,"10th_percentile":584.73,"90th_percentile":10789.56,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":10793.45,"10th_percentile":10793.45,"90th_percentile":10793.45,"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":"Transurethral Prostatectomy Without Cc/Mcc","code_information":[{"code":"714","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8980.77,"maximum":23839.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18680.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9160.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13406.77},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20206.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":20280.93},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15318.55},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":15318.55},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":20280.93},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8980.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":17422.78},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":23839.08},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9160.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9070.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9070.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19741.55},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":8980.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20619.3},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14852.24},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":20619.3},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9070.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9429.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9340.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9070.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc","code_information":[{"code":"715","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18348.87,"maximum":50439.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38165.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18715.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":28366.73},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41284.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":42911.41},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32411.77},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":32411.77},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":42911.41},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18348.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":36863.99},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":50439.93},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18715.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18532.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18532.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":41770.17},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":18348.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":43627.35},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31425.12},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":43627.35},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18532.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19266.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19082.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18532.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - 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Procedures For Malignancy Without Cc/Mcc","code_information":[{"code":"716","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12264.65,"maximum":33163.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25510.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12509.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18650.81},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27595.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":28213.78},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21310.38},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":21310.38},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":28213.78},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12264.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":24237.67},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":33163.7},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12509.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12387.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12387.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":27463.42},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":12264.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":28684.5},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20661.67},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":28684.5},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12387.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12877.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12755.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12387.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc","code_information":[{"code":"717","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15595.37,"maximum":42621.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32438.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15907.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":23969.65},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35089.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":36259.79},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27387.67},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":27387.67},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":36259.79},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15595.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":31149.77},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":42621.32},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15907.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15751.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15751.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":35295.45},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":15595.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":36864.75},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26553.96},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":36864.75},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15751.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16375.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16219.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15751.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":1750.0,"10th_percentile":1750.0,"90th_percentile":14773.05,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30735.18,"10th_percentile":30735.18,"90th_percentile":30735.18,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc","code_information":[{"code":"718","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11249.15,"maximum":30280.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23398.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11474.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17029.16},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25310.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":25760.66},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19457.49},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":19457.49},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":25760.66},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11249.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":22130.26},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":30280.19},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11474.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11361.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11361.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25075.54},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":11249.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26190.45},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18865.18},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":26190.45},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11361.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11811.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11699.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11361.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20558.96,"10th_percentile":20558.96,"90th_percentile":20558.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":14953.84,"maximum":40799.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31103.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15252.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22945.19},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33646.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":34710.05},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26217.12},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":26217.12},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":34710.05},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14953.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":29818.43},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":40799.69},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15252.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15103.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15103.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":33786.92},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":14953.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":35289.15},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25419.05},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":35289.15},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15103.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15701.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15551.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15103.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":12817.38,"10th_percentile":12817.38,"90th_percentile":12817.38,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":5136.31,"10th_percentile":5136.31,"90th_percentile":5136.31,"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."}]}]},{"description":"Malignancy, Male Reproductive System With Cc","code_information":[{"code":"723","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9658.03,"maximum":25762.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20088.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9851.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14488.29},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21730.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":21916.99},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16554.29},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":16554.29},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":21916.99},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9658.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":18828.27},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":25762.17},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9851.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9754.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9754.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21334.09},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":9658.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22282.65},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16050.36},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":22282.65},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9754.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10140.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10044.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9754.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14237.25,"10th_percentile":14237.25,"90th_percentile":14237.25,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":6158.61,"10th_percentile":6158.61,"90th_percentile":6158.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":8473.77,"10th_percentile":8473.77,"90th_percentile":8473.77,"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."}]}]},{"description":"Malignancy, Male Reproductive System Without Cc/Mcc","code_information":[{"code":"724","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5791.38,"maximum":14782.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12046.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5907.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8313.62},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13030.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":12576.33},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9499.13},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":9499.13},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":12576.33},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5791.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":10803.97},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":14782.76},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5907.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5849.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5849.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12241.85},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":5791.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12786.15},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9209.96},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":12786.15},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5849.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6080.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6023.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5849.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":9876.37,"maximum":26382.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20542.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10073.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14836.97},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22221.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":22444.44},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16952.69},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":16952.69},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":22444.44},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9876.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":19281.39},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":26382.16},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10073.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9975.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9975.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21847.52},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":9876.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22818.9},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16436.63},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":22818.9},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9975.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10370.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10271.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9975.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":9259.07,"10th_percentile":9259.07,"90th_percentile":9259.07,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":6317.78,"maximum":16277.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13140.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6444.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9154.24},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14215.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":13847.96},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10459.61},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":10459.61},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":13847.96},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6317.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":11896.39},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":16277.49},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6444.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6380.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6380.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13479.67},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":6317.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14079.0},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10141.21},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":14079.0},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6380.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6633.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6570.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6380.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":5799.99,"10th_percentile":5799.99,"90th_percentile":5799.99,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":645.89,"10th_percentile":280.1,"90th_percentile":5811.56,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":378.12,"10th_percentile":378.12,"90th_percentile":4222.56,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":12359.13,"maximum":33431.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25706.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12606.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18801.69},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27808.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":28442.02},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21482.77},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":21482.77},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":28442.02},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12359.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":24433.74},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":33431.98},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12606.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12482.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12482.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":12871.56,"10th_percentile":12871.56,"90th_percentile":12871.56,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":7026.01,"maximum":18288.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14614.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7166.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10285.2},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15808.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11838.65,"10th_percentile":11838.65,"90th_percentile":11838.65,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12209.68,"10th_percentile":12209.68,"90th_percentile":12209.68,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":24450.25,"10th_percentile":24450.25,"90th_percentile":24450.25},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14860.6,"10th_percentile":14860.6,"90th_percentile":14860.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14860.6,"10th_percentile":14860.6,"90th_percentile":14860.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":8991.09,"maximum":23868.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18701.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9170.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13423.26},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20229.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":20305.87},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15337.39},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":15337.39},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":20305.87},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8991.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":17444.2},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":23868.39},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9170.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9081.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9081.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19765.82},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":8991.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20644.65},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14870.5},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":20644.65},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9081.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9440.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9350.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9081.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":5920.79,"maximum":15150.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12315.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6039.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8520.29},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13321.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":11268.21,"maximum":30334.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23437.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11493.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17059.59},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25353.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":25806.69},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19492.26},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":19492.26},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":25806.69},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11268.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":22169.8},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":30334.3},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11493.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11380.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11380.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25120.35},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":11268.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26237.25},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18898.89},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":26237.25},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11380.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11831.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11718.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11380.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":28965.89,"maximum":80587.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":60249.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29545.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":45321.09},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":65173.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":66735.56},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":28965.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":69702.75},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":50207.43},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":69702.75},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29255.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30414.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30124.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29255.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":16945.92,"maximum":46456.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35247.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17284.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":26126.35},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38128.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":39522.31},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29851.91},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":29851.91},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":39522.31},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16945.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":33952.51},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":46456.23},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17284.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17115.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17115.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":38471.2},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":16945.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":40181.7},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28943.19},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":40181.7},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17115.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17793.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17623.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17115.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":18131.38,"10th_percentile":18131.38,"90th_percentile":18131.38,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":12244.8,"maximum":33107.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25469.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12489.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18619.11},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27550.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":28165.83},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21274.16},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":21274.16},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":28165.83},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12244.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":24196.47},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":33107.33},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12489.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12367.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12367.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":27416.75},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":12244.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":28635.75},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20626.55},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":28635.75},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12367.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12857.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12734.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12367.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":29031.79,"maximum":80774.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":60386.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29612.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":45426.32},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":65321.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":68718.1},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":51904.02},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":51904.02},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":68718.1},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29031.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":59033.8},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":80774.23},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29612.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29322.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29322.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":66890.52},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":29031.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":69864.6},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":50324.01},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":69864.6},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29322.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30483.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30193.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29322.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":14953.04,"maximum":40797.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31102.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15252.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22943.92},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33644.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":34708.13},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26215.68},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":26215.68},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":34708.13},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14953.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":29816.78},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":40797.43},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15252.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15102.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15102.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":33785.05},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":14953.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":35287.2},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25417.64},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":35287.2},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15102.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15700.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15551.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15102.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":14155.38,"10th_percentile":14155.38,"90th_percentile":14155.38,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25063.45,"10th_percentile":25063.45,"90th_percentile":25063.45,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":11908.15,"maximum":32151.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24768.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12146.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18081.52},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26793.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":27352.6},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20659.91},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":20659.91},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":27352.6},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11908.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":23497.85},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":32151.42},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12146.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12027.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12027.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26625.14},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":11908.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":27808.95},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20031.0},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":27808.95},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12027.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12503.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12384.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12027.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":275.0,"10th_percentile":275.0,"90th_percentile":275.0,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":15153.12,"maximum":41365.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31518.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15456.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":23263.43},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34094.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":35191.46},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26580.75},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":26580.75},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":35191.46},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15153.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":30232.0},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":41365.57},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15456.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15304.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15304.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":34255.53},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":15153.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":35778.6},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25771.6},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":35778.6},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15304.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15910.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15759.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15304.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":29982.64,"10th_percentile":29028.64,"90th_percentile":30136.58,"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":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":42050.48,"10th_percentile":42050.48,"90th_percentile":42050.48,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"1 through 10","median_amount":30865.91,"10th_percentile":30865.91,"90th_percentile":280261.15},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":53558.63,"10th_percentile":53558.63,"90th_percentile":53558.63},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":32726.39,"10th_percentile":32522.22,"90th_percentile":34594.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27137.18,"10th_percentile":27137.18,"90th_percentile":28637.18,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":47437.03,"10th_percentile":47437.03,"90th_percentile":47437.03},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":13492.18,"10th_percentile":13492.18,"90th_percentile":13492.18,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33858.19,"10th_percentile":33858.19,"90th_percentile":33858.19,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":10436.12,"maximum":27971.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21707.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10644.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15730.84},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23481.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":23796.63},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17974.02},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":17974.02},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":23796.63},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10436.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":20443.01},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":27971.58},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10644.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10540.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10540.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15198.32,"10th_percentile":15198.32,"90th_percentile":15198.32,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"1 through 10","median_amount":25852.69,"10th_percentile":25852.69,"90th_percentile":25852.69},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":25394.39,"10th_percentile":16781.23,"90th_percentile":31736.2},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":21608.44,"10th_percentile":21597.41,"90th_percentile":23856.26,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20463.53,"10th_percentile":18192.02,"90th_percentile":23622.81,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":15165.39,"10th_percentile":14767.88,"90th_percentile":16522.88,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13064.67,"10th_percentile":13064.67,"90th_percentile":14022.88,"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":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":9571.1,"10th_percentile":9571.1,"90th_percentile":9571.1,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15595.82,"10th_percentile":13115.22,"90th_percentile":17825.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":41115.0,"10th_percentile":41115.0,"90th_percentile":42928.32},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"1 through 10","median_amount":1298.11,"10th_percentile":1298.11,"90th_percentile":23189.3},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":3783.03,"10th_percentile":3783.03,"90th_percentile":3783.03,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22118.76,"10th_percentile":21800.76,"90th_percentile":45231.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13267.56,"10th_percentile":13267.56,"90th_percentile":13267.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":16854.61,"maximum":46196.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35057.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17191.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":25980.54},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37922.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":39301.74},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29685.31},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":29685.31},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":39301.74},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16854.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":33763.02},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":46196.96},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17191.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17023.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17023.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":38256.49},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":16854.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":39957.45},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28781.66},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":39957.45},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17023.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17697.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17528.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17023.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":34913.93,"10th_percentile":34913.93,"90th_percentile":34913.93,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":9616.74,"maximum":25644.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20002.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9809.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14422.36},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21637.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":21817.25},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16478.96},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":16478.96},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":21817.25},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9616.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":18742.59},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":25644.94},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9809.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9712.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9712.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21237.01},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":9616.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22181.25},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15977.33},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":22181.25},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9712.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10097.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10001.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9712.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":14377.41,"maximum":39162.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29905.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14664.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22024.69},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32349.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":33317.58},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25165.37},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":25165.37},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":33317.58},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14377.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":28622.2},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":39162.92},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14664.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14521.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14521.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":32431.48},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":14377.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":33873.45},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24399.31},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":33873.45},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14521.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15096.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14952.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14521.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":7411.08,"maximum":19381.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15415.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7559.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10900.14},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16674.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":16489.05},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12454.47},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":12454.47},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":16489.05},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7411.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":14165.28},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":19381.94},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7559.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7485.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7485.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16050.51},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":7411.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16764.15},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12075.35},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":16764.15},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7485.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7781.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7707.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7485.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12499.99,"10th_percentile":12499.99,"90th_percentile":12499.99,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":3870.63,"10th_percentile":3870.63,"90th_percentile":3870.63,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":11600.09,"maximum":31276.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24128.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11832.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17589.58},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26100.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":26608.41},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20097.82},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":20097.82},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":26608.41},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11600.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":22858.54},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":31276.68},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11832.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11716.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11716.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25900.75},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":11600.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":27052.35},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19486.02},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":27052.35},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11716.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12180.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12064.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11716.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18616.9,"10th_percentile":18616.9,"90th_percentile":18616.9,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":20971.36,"maximum":57886.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43620.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21390.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":32554.6},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":47185.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":49246.57},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37196.82},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":37196.82},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":49246.57},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20971.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":42306.35},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":57886.54},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21390.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21181.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21181.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":47936.84},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":20971.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":50068.2},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36064.51},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":50068.2},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21181.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22019.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21810.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21181.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":12302.76,"maximum":33271.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25589.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12548.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18711.67},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27681.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":28305.84},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21379.91},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":21379.91},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":28305.84},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12302.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":24316.76},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":33271.91},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12548.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12425.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12425.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":27553.04},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":12302.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":28778.1},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20729.09},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":28778.1},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12425.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12917.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12794.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12425.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15854.48,"10th_percentile":15854.48,"90th_percentile":15854.48,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":15207.91,"maximum":41521.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31632.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15512.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":23350.91},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34217.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":34384.35},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":15207.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":35913.15},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25868.52},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":35913.15},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15359.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15968.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15816.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15359.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":13402.1,"10th_percentile":13402.1,"90th_percentile":13402.1,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":13307.72,"10th_percentile":13307.72,"90th_percentile":13307.72,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28364.4,"10th_percentile":28364.4,"90th_percentile":28364.4,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14154.94,"10th_percentile":14154.94,"90th_percentile":14154.94,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":9222.14,"maximum":24524.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19182.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9406.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13792.22},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20749.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20309.12},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":9222.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21212.1},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15279.24},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":21212.1},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9314.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9683.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9591.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9314.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":569.7,"10th_percentile":569.7,"90th_percentile":569.7,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":7436.86,"10th_percentile":7436.86,"90th_percentile":7436.86,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":754.01,"10th_percentile":754.01,"90th_percentile":8399.87,"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."}]}]},{"description":"Malignancy, Female Reproductive System Without Cc/Mcc","code_information":[{"code":"756","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8211.41,"maximum":21654.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17079.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8375.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12178.18},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18475.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":18422.39},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13914.76},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":13914.76},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":18422.39},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8211.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":15826.16},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":21654.47},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8375.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8293.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8293.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17932.44},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":8211.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18729.75},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13491.18},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":18729.75},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8293.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8621.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8539.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8293.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":11954.2,"maximum":32282.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24864.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12193.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18155.06},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26896.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":27463.84},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20743.94},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":20743.94},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":27463.84},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11954.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":23593.42},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":32282.19},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12193.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12073.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12073.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26733.43},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":11954.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":27922.05},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20112.47},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":27922.05},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12073.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12551.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12432.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12073.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":8358.29,"maximum":22071.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17385.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8525.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12412.74},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18806.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":18777.22},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14182.77},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":14182.77},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":18777.22},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8358.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":16130.98},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":22071.56},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8525.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8441.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8441.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18277.83},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":8358.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19090.5},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13751.03},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":19090.5},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8441.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8776.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8692.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8441.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":7797.12,"10th_percentile":7797.12,"90th_percentile":7797.12,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15621.02,"10th_percentile":15621.02,"90th_percentile":15621.02,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":1958.74,"10th_percentile":1958.74,"90th_percentile":1958.74,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2565.98,"10th_percentile":2565.98,"90th_percentile":2565.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":5854.1,"maximum":14960.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12176.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5971.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8413.78},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13171.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":12727.85},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9613.57},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":9613.57},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":12727.85},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5854.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":10934.14},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":14960.86},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5971.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5912.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5912.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12389.35},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":5854.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12940.2},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9320.93},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":12940.2},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5912.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6146.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6088.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5912.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":5052.24,"10th_percentile":5052.24,"90th_percentile":5052.24,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"1 through 10","median_amount":16141.11,"10th_percentile":16141.11,"90th_percentile":16141.11},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":12012.32,"10th_percentile":12012.32,"90th_percentile":12012.32,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":2009.15,"10th_percentile":2009.15,"90th_percentile":2009.15,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":8584.58,"maximum":22714.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17855.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8756.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12774.09},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19315.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":19323.85},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14595.65},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":14595.65},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":19323.85},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8584.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":16600.58},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":22714.09},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8756.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8670.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8670.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18809.92},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":8584.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19646.25},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14151.35},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":19646.25},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8670.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9013.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8927.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8670.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":7506.9,"10th_percentile":7506.9,"90th_percentile":8137.3,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12496.42,"10th_percentile":12496.42,"90th_percentile":12496.42,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21130.28,"10th_percentile":21130.28,"90th_percentile":21130.28,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13585.51,"10th_percentile":13585.51,"90th_percentile":13585.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11921.05,"10th_percentile":11921.05,"90th_percentile":11921.05,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":370.87,"10th_percentile":370.87,"90th_percentile":370.87,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":5114.91,"maximum":12861.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10639.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5217.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":7233.37},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11508.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6937.68,"10th_percentile":6937.68,"90th_percentile":6937.68,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":1891.16,"10th_percentile":1891.16,"90th_percentile":1891.16,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With O.R. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13899.99,"10th_percentile":9174.52,"90th_percentile":17690.95,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"1 through 10","median_amount":15371.4,"10th_percentile":15371.4,"90th_percentile":15858.58},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":17989.02,"10th_percentile":17989.02,"90th_percentile":24181.66},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":21366.81,"10th_percentile":21366.81,"90th_percentile":21366.81,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15579.32,"10th_percentile":14136.7,"90th_percentile":18891.12,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13378.33,"10th_percentile":12889.2,"90th_percentile":15111.4,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16586.7,"10th_percentile":16586.7,"90th_percentile":16586.7,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"11","median_amount":16924.33,"10th_percentile":12536.2,"90th_percentile":25519.5},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_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":2438.2,"10th_percentile":2438.2,"90th_percentile":2438.2,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":2095.27,"10th_percentile":2095.27,"90th_percentile":2095.27,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":2558.8,"10th_percentile":2438.2,"90th_percentile":5952.78,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19938.41,"10th_percentile":19938.41,"90th_percentile":21377.85,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11904.27,"10th_percentile":11904.27,"90th_percentile":15051.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postpartum And Post Abortion Diagnoses With O.R. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21783.19,"10th_percentile":21783.19,"90th_percentile":21783.19,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - 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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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12107.38,"10th_percentile":12107.38,"90th_percentile":12831.58,"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":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16268.45,"10th_percentile":16268.45,"90th_percentile":16268.45,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":2864.12,"10th_percentile":2864.12,"90th_percentile":2864.12,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":5783.44,"maximum":14760.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12029.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5899.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8300.94},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13012.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":12557.15},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9484.64},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":9484.64},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":12557.15},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5783.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":10787.49},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":14760.21},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5899.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5841.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5841.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12223.18},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":5783.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12766.65},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9195.92},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":12766.65},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5841.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6072.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6014.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5841.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":9834.0,"10th_percentile":9834.0,"90th_percentile":9834.0,"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":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"1 through 10","median_amount":8849.94,"10th_percentile":8849.94,"90th_percentile":8849.94},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":7874.33,"10th_percentile":7874.33,"90th_percentile":7874.33},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":13379.42,"10th_percentile":13379.42,"90th_percentile":13379.42,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11185.54,"10th_percentile":11185.54,"90th_percentile":11185.54,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9490.77,"10th_percentile":7490.0,"90th_percentile":9834.88,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11185.54,"10th_percentile":11049.02,"90th_percentile":11185.54,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":6195.24,"10th_percentile":6117.37,"90th_percentile":11963.27},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"1 through 10","median_amount":13121.1,"10th_percentile":13121.1,"90th_percentile":13121.1},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_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":2218.35,"10th_percentile":2218.35,"90th_percentile":2218.35,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":6289.61,"10th_percentile":6289.61,"90th_percentile":6289.61,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":1475.72,"10th_percentile":1412.42,"90th_percentile":2423.16,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12766.65,"10th_percentile":9131.0,"90th_percentile":12976.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8995.38,"10th_percentile":8995.38,"90th_percentile":8995.38,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17049.82,"10th_percentile":17049.82,"90th_percentile":17049.82,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":14318.99,"10th_percentile":14318.99,"90th_percentile":14318.99},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":2379.03,"10th_percentile":2379.03,"90th_percentile":2379.03,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":20078.14,"maximum":55350.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41762.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20479.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":31128.21},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45175.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":26887.13,"10th_percentile":26887.13,"90th_percentile":31746.42,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14685.36,"10th_percentile":14685.36,"90th_percentile":17172.33,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"1 through 10","median_amount":17638.56,"10th_percentile":17638.56,"90th_percentile":17638.56},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":20603.11,"10th_percentile":20603.11,"90th_percentile":20603.11},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":19730.39,"10th_percentile":19728.99,"90th_percentile":20818.71,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17301.74,"10th_percentile":17301.74,"90th_percentile":19554.72,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10551.21,"10th_percentile":8758.31,"90th_percentile":14294.53,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17446.6,"10th_percentile":16378.19,"90th_percentile":17792.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11075.11,"10th_percentile":11075.11,"90th_percentile":11075.11,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"1 through 10","median_amount":15584.57,"10th_percentile":15584.57,"90th_percentile":15584.57},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":14745.95,"10th_percentile":7766.45,"90th_percentile":17428.08},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":18856.22,"10th_percentile":18856.22,"90th_percentile":18856.22,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13693.86,"10th_percentile":11718.58,"90th_percentile":17756.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11836.83,"10th_percentile":6040.32,"90th_percentile":13978.13,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":13093.86,"10th_percentile":11194.65,"90th_percentile":13693.86,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":15407.46,"10th_percentile":2381.73,"90th_percentile":25906.78},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"1 through 10","median_amount":15164.13,"10th_percentile":15164.13,"90th_percentile":15164.13},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":3069.17,"10th_percentile":3069.17,"90th_percentile":3069.17,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6003.21,"10th_percentile":6003.21,"90th_percentile":6003.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6000.0,"10th_percentile":6000.0,"90th_percentile":6000.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":13681.89,"maximum":37187.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28458.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13955.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":20914.01},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30784.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14416.56,"10th_percentile":14416.56,"90th_percentile":14416.56,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":15746.26,"10th_percentile":15746.26,"90th_percentile":28971.07},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":30147.5,"10th_percentile":30147.5,"90th_percentile":30147.5,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25332.46,"10th_percentile":22813.29,"90th_percentile":28513.48,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21923.57,"10th_percentile":20498.57,"90th_percentile":22308.8,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26087.78,"10th_percentile":24732.46,"90th_percentile":27380.05,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":16985.84,"10th_percentile":16985.84,"90th_percentile":16985.84},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"15","median_amount":3948.85,"10th_percentile":3029.9,"90th_percentile":8620.79,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27093.63,"10th_percentile":24067.0,"90th_percentile":29388.37,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21484.46,"10th_percentile":21484.46,"90th_percentile":21484.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":9452.39,"maximum":25178.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19660.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9641.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14159.91},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21267.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15359.91,"10th_percentile":13462.56,"90th_percentile":17488.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"49","median_amount":13981.35,"10th_percentile":10298.58,"90th_percentile":16298.58,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14606.09,"10th_percentile":14606.09,"90th_percentile":14606.09,"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":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"33","median_amount":15356.03,"10th_percentile":13156.72,"90th_percentile":17911.18,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"15","median_amount":16052.46,"10th_percentile":13869.7,"90th_percentile":19693.54},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"1 through 10","median_amount":1516.4,"10th_percentile":692.57,"90th_percentile":12250.57},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"1 through 10","median_amount":3399.15,"10th_percentile":3399.15,"90th_percentile":3776.66,"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":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_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":3776.66,"10th_percentile":3029.9,"90th_percentile":7486.27,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"34","median_amount":3776.66,"10th_percentile":3029.9,"90th_percentile":7486.27,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"94","median_amount":3090.14,"10th_percentile":3029.9,"90th_percentile":3948.85,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"25","median_amount":19310.96,"10th_percentile":3948.85,"90th_percentile":21777.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12686.57,"10th_percentile":11934.23,"90th_percentile":15011.87,"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":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":8197.91,"maximum":21616.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17051.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8361.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12156.63},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18445.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"1 through 10","median_amount":3120.79,"10th_percentile":3120.79,"90th_percentile":3120.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"15","median_amount":12640.46,"10th_percentile":10097.98,"90th_percentile":17810.79},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"24","median_amount":12749.83,"10th_percentile":8020.16,"90th_percentile":23200.84},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"24","median_amount":16793.93,"10th_percentile":16575.01,"90th_percentile":18987.71,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"15","median_amount":13582.98,"10th_percentile":10217.63,"90th_percentile":16500.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10589.32,"10th_percentile":10589.32,"90th_percentile":10589.32,"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":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"35","median_amount":13582.98,"10th_percentile":11266.39,"90th_percentile":14849.65,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13992.73,"10th_percentile":13992.73,"90th_percentile":13992.73,"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":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"23","median_amount":16569.56,"10th_percentile":3274.76,"90th_percentile":22978.41},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"1 through 10","median_amount":11559.76,"10th_percentile":11559.76,"90th_percentile":17108.37},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"1 through 10","median_amount":3332.89,"10th_percentile":3332.89,"90th_percentile":3399.15,"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":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":12784.64,"10th_percentile":12784.64,"90th_percentile":12784.64},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"19","median_amount":3029.9,"10th_percentile":3029.9,"90th_percentile":7486.27,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"18","median_amount":3029.9,"10th_percentile":3029.9,"90th_percentile":3776.66,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"95","median_amount":3029.9,"10th_percentile":3029.9,"90th_percentile":3776.66,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"27","median_amount":16453.78,"10th_percentile":6707.42,"90th_percentile":18696.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8594.38,"10th_percentile":5464.63,"90th_percentile":16453.78,"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":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16453.78,"10th_percentile":16453.78,"90th_percentile":16453.78,"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":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":14894.29,"maximum":40630.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30980.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15192.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22850.09},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33512.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":64538.85,"10th_percentile":64538.85,"90th_percentile":64538.85},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":4218.0,"10th_percentile":4218.0,"90th_percentile":6680.26,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":926.39,"10th_percentile":389.9,"90th_percentile":2846.44,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":47775.13,"maximum":133996.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":99372.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48730.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":75357.64},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":107494.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":113996.33},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":86103.48},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":86103.48},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":113996.33},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47775.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":97931.05},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":133996.21},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48730.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48252.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48252.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":110964.55},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":47775.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":115898.25},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":83482.4},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":115898.25},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48252.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50163.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49686.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48252.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":90523.2,"10th_percentile":90523.2,"90th_percentile":90523.2,"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":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":71001.71,"10th_percentile":71001.71,"90th_percentile":71001.71,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":28318.88,"10th_percentile":28318.88,"90th_percentile":89374.64},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_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":89874.13,"10th_percentile":89874.13,"90th_percentile":89874.13,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":6745.79,"10th_percentile":49.41,"90th_percentile":7417.68,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"13","median_amount":13993.59,"10th_percentile":8448.83,"90th_percentile":24589.45,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":98138.53,"10th_percentile":98138.53,"90th_percentile":98138.53,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":32812.69,"maximum":91510.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":68250.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33468.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":51464.06},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":73828.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":77851.62},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":58802.73},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":58802.73},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":77851.62},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32812.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":66880.14},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":91510.16},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33468.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33140.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33140.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":75781.12},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":32812.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":79150.5},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":57012.71},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":79150.5},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33140.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34453.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34125.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33140.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":44.58,"10th_percentile":44.58,"90th_percentile":44.58,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":71679.74,"10th_percentile":71679.74,"90th_percentile":71679.74,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"1 through 10","median_amount":20012.82,"10th_percentile":20012.82,"90th_percentile":20012.82,"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":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":4934.04,"10th_percentile":4934.04,"90th_percentile":4934.04,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"11","median_amount":4279.19,"10th_percentile":831.95,"90th_percentile":10231.21,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":20031.3,"maximum":55217.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41665.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20431.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":31053.41},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45070.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":6757.62,"10th_percentile":6757.62,"90th_percentile":6757.62},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"1 through 10","median_amount":2748.06,"10th_percentile":2748.06,"90th_percentile":2748.06,"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":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_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":831.95,"10th_percentile":831.95,"90th_percentile":831.95,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":9822.33,"10th_percentile":49.41,"90th_percentile":24227.62,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"21","median_amount":1234.4,"10th_percentile":49.41,"90th_percentile":5274.42,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12438.34,"10th_percentile":12438.34,"90th_percentile":12438.34,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":33690.83,"maximum":94003.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":70076.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34364.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":52866.36},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":75804.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"1 through 10","median_amount":5625.56,"10th_percentile":5625.56,"90th_percentile":5625.56},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":37748.95,"10th_percentile":37748.95,"90th_percentile":37748.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"13","median_amount":8628.35,"10th_percentile":6754.7,"90th_percentile":20540.59},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"1 through 10","median_amount":915.15,"10th_percentile":49.41,"90th_percentile":22527.55,"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":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_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":1777.2,"10th_percentile":1777.2,"90th_percentile":5268.29,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":1386.75,"10th_percentile":882.68,"90th_percentile":7260.88,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"31","median_amount":1386.75,"10th_percentile":831.95,"90th_percentile":4054.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":882.68,"10th_percentile":44.58,"90th_percentile":23114.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5274.42,"10th_percentile":5274.42,"90th_percentile":9917.71,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6720.56,"10th_percentile":6720.56,"90th_percentile":6720.56,"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":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":695.65,"10th_percentile":695.65,"90th_percentile":16874.0,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"29","median_amount":7537.52,"10th_percentile":3087.81,"90th_percentile":10497.16},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"1 through 10","median_amount":4895.28,"10th_percentile":4895.28,"90th_percentile":4895.28},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"14","median_amount":652.91,"10th_percentile":49.41,"90th_percentile":1954.92,"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":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"47","median_amount":580.48,"10th_percentile":44.58,"90th_percentile":1777.2,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"75","median_amount":831.95,"10th_percentile":580.48,"90th_percentile":1777.2,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"254","median_amount":831.95,"10th_percentile":49.41,"90th_percentile":1777.2,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3633.76,"10th_percentile":54.9,"90th_percentile":11365.41,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13132.71,"10th_percentile":7352.41,"90th_percentile":15533.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":2171.65,"maximum":4886.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4517.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2215.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":2533.26},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4886.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"1 through 10","median_amount":597.89,"10th_percentile":597.89,"90th_percentile":597.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"1 through 10","median_amount":2500.43,"10th_percentile":2500.43,"90th_percentile":2500.43},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":1780.64,"10th_percentile":1780.64,"90th_percentile":1780.64},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"58","median_amount":4533.1,"10th_percentile":629.89,"90th_percentile":5155.13,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3132.26,"10th_percentile":638.53,"90th_percentile":3316.48,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2754.04,"10th_percentile":2754.04,"90th_percentile":2754.04,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":642.96,"10th_percentile":642.96,"90th_percentile":642.96,"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":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3132.26,"10th_percentile":2915.31,"90th_percentile":3132.26,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"37","median_amount":5964.59,"10th_percentile":3248.93,"90th_percentile":8750.04},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"1 through 10","median_amount":4421.69,"10th_percentile":4421.69,"90th_percentile":4839.85},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"1 through 10","median_amount":652.91,"10th_percentile":638.53,"90th_percentile":652.91,"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":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":2408.8,"10th_percentile":2408.8,"90th_percentile":2408.8},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"61","median_amount":580.48,"10th_percentile":58.65,"90th_percentile":580.48,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"71","median_amount":580.48,"10th_percentile":49.41,"90th_percentile":593.55,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"229","median_amount":580.48,"10th_percentile":44.58,"90th_percentile":593.55,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"15","median_amount":3633.76,"10th_percentile":3633.76,"90th_percentile":3896.1,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2711.49,"10th_percentile":2711.49,"90th_percentile":2711.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":9850.97,"maximum":26310.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20490.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10047.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14796.39},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22164.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23217.52,"10th_percentile":23217.52,"90th_percentile":23217.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":8528.2,"maximum":22554.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17738.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8698.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12684.07},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19188.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":19187.67},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14492.79},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":14492.79},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":19187.67},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8528.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":16483.59},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":22554.02},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8698.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8613.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8613.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18677.37},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":8528.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19507.8},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14051.62},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":19507.8},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8613.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8954.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8869.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8613.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":8184.41,"maximum":21577.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17023.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8348.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12135.07},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18414.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":18357.18},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13865.51},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":13865.51},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":18357.18},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8184.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":15770.14},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":21577.82},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8348.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8266.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8266.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17868.96},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":8184.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18663.45},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13443.43},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":18663.45},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8266.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8593.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8511.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8266.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13345.67,"10th_percentile":13345.67,"90th_percentile":13345.67,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":36543.57,"maximum":102104.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":76010.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37274.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":57421.92},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":82223.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":86864.3},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":65610.17},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":65610.17},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":86864.3},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36543.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":74622.69},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":102104.05},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37274.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36909.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36909.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":84554.11},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":36543.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":88313.55},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":63612.93},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":88313.55},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36909.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38370.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38005.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36909.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":62808.14,"10th_percentile":62808.14,"90th_percentile":62808.14,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":22891.19,"maximum":63337.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":47613.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23349.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":35620.38},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":51505.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":53884.29},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40699.78},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":40699.78},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":53884.29},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22891.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":46290.48},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":63337.92},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23349.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23120.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23120.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":52451.22},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":22891.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":54783.3},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39460.83},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":54783.3},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23120.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24035.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23806.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23120.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":1096.42,"10th_percentile":1096.42,"90th_percentile":1096.42,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":52993.28,"10th_percentile":52993.28,"90th_percentile":52993.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":21451.88,"10th_percentile":21451.88,"90th_percentile":21451.88,"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."}]}]},{"description":"Splenic Procedures Without Cc/Mcc","code_information":[{"code":"801","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15741.46,"maximum":43036.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32742.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16056.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":24202.94},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35418.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":36612.7},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27654.23},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":27654.23},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":36612.7},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15741.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":31452.95},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":43036.15},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16056.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15898.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15898.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":32218.0,"maximum":89821.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":67013.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32862.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":50514.4},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":72490.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":76415.04},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":57717.66},{"payer_name":"Blue Cross","plan_name":"Health Options - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":11351.58,"maximum":30571.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23611.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11578.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17192.72},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25541.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":26008.08},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19644.37},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":19644.37},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":26008.08},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11351.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":22342.81},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":30571.02},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11578.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11465.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11465.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25316.38},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":11351.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26442.0},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19046.38},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":26442.0},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11465.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11919.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11805.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11465.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":20334.85,"10th_percentile":20334.85,"90th_percentile":20334.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13706.0,"10th_percentile":13706.0,"90th_percentile":13706.0,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":9153.86,"maximum":24330.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19040.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9336.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13683.18},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20596.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":20699.06},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15634.37},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":15634.37},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":20699.06},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9153.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":17781.98},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":24330.56},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9336.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9245.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9245.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13683.18,"10th_percentile":13683.18,"90th_percentile":13683.18,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"1 through 10","median_amount":12404.36,"10th_percentile":12404.36,"90th_percentile":12404.36},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":23977.48,"10th_percentile":23977.48,"90th_percentile":23977.48},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":21163.93,"10th_percentile":21163.93,"90th_percentile":21163.93,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15045.65,"10th_percentile":15045.65,"90th_percentile":15045.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13342.26,"10th_percentile":13342.26,"90th_percentile":13342.26,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":954.0,"10th_percentile":954.0,"90th_percentile":30681.0},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_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":1800.09,"10th_percentile":1800.09,"90th_percentile":1800.09,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":2133.01,"10th_percentile":2041.35,"90th_percentile":4200.53,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18150.63,"10th_percentile":18150.63,"90th_percentile":18786.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9253.59,"10th_percentile":9253.59,"90th_percentile":9253.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":6571.85,"maximum":16998.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13669.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6703.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9559.97},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14786.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"1 through 10","median_amount":1896.57,"10th_percentile":1896.57,"90th_percentile":1896.57,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":9174.52,"10th_percentile":7250.27,"90th_percentile":12593.2,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"13","median_amount":9004.5,"10th_percentile":1848.28,"90th_percentile":12567.42},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"21","median_amount":11926.7,"10th_percentile":6434.39,"90th_percentile":16113.65},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"29","median_amount":13661.75,"10th_percentile":13444.22,"90th_percentile":15172.47,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"26","median_amount":11915.65,"10th_percentile":7077.33,"90th_percentile":13197.74,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"64","median_amount":8341.1,"10th_percentile":3974.1,"90th_percentile":9974.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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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":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"38","median_amount":10743.88,"10th_percentile":7940.77,"90th_percentile":11343.88,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"16","median_amount":15691.8,"10th_percentile":1251.0,"90th_percentile":20712.4},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"1 through 10","median_amount":13262.14,"10th_percentile":4819.57,"90th_percentile":15084.15},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"1 through 10","median_amount":2245.49,"10th_percentile":2041.35,"90th_percentile":2346.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"36","median_amount":2041.35,"10th_percentile":1841.33,"90th_percentile":4200.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":12225.0,"10th_percentile":12225.0,"90th_percentile":12225.0,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":41653.69,"10th_percentile":41653.69,"90th_percentile":41653.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"1 through 10","median_amount":861.8,"10th_percentile":861.8,"90th_percentile":861.8,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":16851.32,"10th_percentile":861.8,"90th_percentile":16856.27,"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":"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":10636.21,"maximum":28539.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22123.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10848.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16050.35},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23931.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22589.0,"10th_percentile":22589.0,"90th_percentile":22589.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":662.98,"10th_percentile":662.98,"90th_percentile":662.98,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20412.67,"10th_percentile":19415.96,"90th_percentile":21012.67,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":50523.16,"10th_percentile":50523.16,"90th_percentile":50523.16},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":9380.08,"10th_percentile":466.03,"90th_percentile":12113.74,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12750.0,"10th_percentile":12750.0,"90th_percentile":12750.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17780.83,"10th_percentile":17780.83,"90th_percentile":17780.83,"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":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":466.03,"10th_percentile":466.03,"90th_percentile":10247.12,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"1 through 10","median_amount":9853.02,"10th_percentile":9853.02,"90th_percentile":9853.02,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":8895.02,"maximum":23595.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18501.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9072.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13269.84},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20013.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":16380.83,"10th_percentile":16380.83,"90th_percentile":16380.83},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":11735.07,"maximum":31659.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24408.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11969.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17805.12},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26403.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":14657.27,"10th_percentile":14657.27,"90th_percentile":14657.27},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17948.43,"10th_percentile":17948.43,"90th_percentile":17948.43,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22055.97,"10th_percentile":22055.97,"90th_percentile":22055.97,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"13","median_amount":2704.96,"10th_percentile":568.92,"90th_percentile":11111.72,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":4449.84,"10th_percentile":2944.55,"90th_percentile":5054.31,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25587.29,"10th_percentile":25587.29,"90th_percentile":25587.29,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":529.4,"10th_percentile":529.4,"90th_percentile":10366.57,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":7875.56,"maximum":20700.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16381.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8033.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11641.86},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17720.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"17","median_amount":347.27,"10th_percentile":347.27,"90th_percentile":7091.8,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11701.45,"10th_percentile":11701.45,"90th_percentile":11701.45,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":17637.12,"10th_percentile":17637.12,"90th_percentile":17637.12,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12057.78,"10th_percentile":12057.78,"90th_percentile":12121.25,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6828.29,"10th_percentile":6828.29,"90th_percentile":6828.29,"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":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":347.27,"10th_percentile":347.27,"90th_percentile":6681.13,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14468.3,"10th_percentile":12770.76,"90th_percentile":14468.3,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"1 through 10","median_amount":2342.03,"10th_percentile":2342.03,"90th_percentile":2342.03,"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":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"60","median_amount":462.92,"10th_percentile":347.27,"90th_percentile":8369.85,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":2907.01,"10th_percentile":2303.82,"90th_percentile":4449.84,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":3159.8,"10th_percentile":2119.47,"90th_percentile":5857.54,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14707.18,"10th_percentile":2800.0,"90th_percentile":17102.78,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5561.59,"10th_percentile":5561.59,"90th_percentile":5561.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"20","median_amount":373.2,"10th_percentile":347.27,"90th_percentile":7165.59,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"12","median_amount":6916.63,"10th_percentile":373.2,"90th_percentile":7233.92,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":7022.28,"10th_percentile":7022.28,"90th_percentile":7022.28,"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":"Coagulation Disorders","code_information":[{"code":"813","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12695.77,"maximum":34387.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26407.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12949.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19339.28},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28565.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":29255.25},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22097.02},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":22097.02},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":29255.25},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12695.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":25132.37},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":34387.89},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12949.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12822.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12822.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":28477.2},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":12695.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29743.35},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21424.36},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":29743.35},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12822.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13330.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13203.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12822.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":25141.86,"10th_percentile":25141.86,"90th_percentile":25141.86,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":1140.0,"10th_percentile":625.97,"90th_percentile":12046.24,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":13737.55,"10th_percentile":13737.55,"90th_percentile":19216.44},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19404.14,"10th_percentile":19404.14,"90th_percentile":19404.14,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":582.49,"10th_percentile":582.49,"90th_percentile":11297.72,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20581.87,"10th_percentile":20581.87,"90th_percentile":20581.87,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"1 through 10","median_amount":67747.6,"10th_percentile":67747.6,"90th_percentile":67747.6},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":11514.07,"10th_percentile":11514.07,"90th_percentile":11514.07,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":594.01,"10th_percentile":582.49,"90th_percentile":11514.2,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":798.83,"10th_percentile":582.49,"90th_percentile":9880.16,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":11405.21,"10th_percentile":582.49,"90th_percentile":11557.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Reticuloendothelial And Immunity Disorders With Mcc","code_information":[{"code":"814","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17470.73,"maximum":47946.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36339.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17820.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":26964.43},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39309.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":40790.11},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30809.5},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":30809.5},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":40790.11},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17470.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":35041.64},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":47946.45},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17820.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17645.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17645.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":39705.28},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":17470.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":41470.65},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29871.63},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":41470.65},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17645.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18344.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18169.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17645.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":786.63,"10th_percentile":786.63,"90th_percentile":5136.45,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":845.35,"10th_percentile":845.35,"90th_percentile":845.35,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":8636.19,"maximum":22860.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17963.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8808.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12856.51},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19431.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":19448.52},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14689.82},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":14689.82},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":19448.52},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8636.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":16707.68},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":22860.63},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8808.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8722.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8722.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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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: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":7646.34,"10th_percentile":382.35,"90th_percentile":7646.34,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12250.74,"10th_percentile":12250.74,"90th_percentile":12250.74,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1615.67,"10th_percentile":382.35,"90th_percentile":7782.56,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":4475.71,"10th_percentile":4475.71,"90th_percentile":4475.71,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19813.95,"10th_percentile":19813.95,"90th_percentile":19813.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":410.88,"10th_percentile":280.72,"90th_percentile":531.05,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":5603.21,"maximum":14248.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11654.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5715.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8013.13},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12607.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":12121.76},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9155.78},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":9155.78},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":12121.76},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5603.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":10413.46},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":14248.44},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5715.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5659.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5659.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11799.38},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":5603.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12324.0},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8877.07},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":12324.0},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5659.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5883.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5827.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5659.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":2013.37,"10th_percentile":2013.37,"90th_percentile":2013.37,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":18700.6,"maximum":51438.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38897.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19074.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":28928.41},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42076.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":43761.09},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33053.54},{"payer_name":"Blue Cross","plan_name":"Health Options - 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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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":12273.83,"10th_percentile":12273.83,"90th_percentile":12273.83,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses With O.R. 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HMO","methodology":"fee schedule","standard_charge_dollar":16793.33},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":22233.46},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9789.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":19100.14},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":26134.16},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9984.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9886.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9886.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16331.12,"10th_percentile":16331.12,"90th_percentile":16695.14,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":5195.2,"10th_percentile":5195.2,"90th_percentile":5195.2,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses With O.R. 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HMO","methodology":"fee schedule","standard_charge_dollar":12457.37},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":16492.88},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7412.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":14168.57},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":19386.45},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7560.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7486.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7486.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10932.43,"10th_percentile":10932.43,"90th_percentile":10932.43,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11254.64,"10th_percentile":11254.64,"90th_percentile":11254.64,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12800.27,"10th_percentile":12800.27,"90th_percentile":12800.27,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Leukemia With Major O.R. 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Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":109495.23},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":47150.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":114363.6},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":82376.98},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":114363.6},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47621.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49507.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49036.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47621.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":3071.52,"10th_percentile":3071.52,"90th_percentile":3071.52,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":18359.19,"maximum":50469.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38187.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18726.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":28383.21},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41308.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":42936.35},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32430.6},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":32430.6},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":42936.35},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18359.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":36885.41},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":50469.24},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18726.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18542.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18542.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":41794.44},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":18359.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":43652.7},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31443.38},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":43652.7},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18542.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19277.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19093.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18542.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":10144.74,"maximum":27144.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21101.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10347.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15265.52},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22825.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":23092.72},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17442.35},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":17442.35},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":23092.72},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10144.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":19838.31},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":27144.18},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10347.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10246.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10246.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - 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PPO","methodology":"fee schedule","standard_charge_dollar":87936.46},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":66420.0},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":66420.0},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":87936.46},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36987.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":75543.75},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":103364.32},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37727.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37357.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37357.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":33178.48,"10th_percentile":33178.48,"90th_percentile":33178.48,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":85556.94,"10th_percentile":85556.94,"90th_percentile":85556.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1760.82,"10th_percentile":1760.82,"90th_percentile":36829.59,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":89403.6,"10th_percentile":89403.6,"90th_percentile":89403.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":33106.4,"10th_percentile":33106.4,"90th_percentile":33106.4,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":18573.56,"maximum":51077.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38633.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18945.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":28725.54},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41790.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":43454.21},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32821.75},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":32821.75},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":43454.21},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18573.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":37330.29},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":51077.95},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18945.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18759.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18759.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":827.6,"10th_percentile":827.6,"90th_percentile":827.6,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":827.6,"10th_percentile":827.6,"90th_percentile":827.6,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":11299.17,"maximum":30422.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23502.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11525.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17109.04},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25423.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":25881.49},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19548.76},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":19548.76},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":25881.49},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11299.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":22234.06},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":30422.22},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11525.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11412.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11412.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25193.16},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":11299.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26313.3},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18953.67},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":26313.3},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11412.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11864.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11751.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11412.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":9550.84,"10th_percentile":9550.84,"90th_percentile":9550.84,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":37725.8,"maximum":105461.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":78469.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38480.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":59309.83},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":84883.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":89720.2},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":67767.29},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":67767.29},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":89720.2},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37725.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":77076.11},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":105461.0},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38480.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38103.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38103.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":87334.06},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":37725.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":91217.1},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":65704.38},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":91217.1},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38103.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39612.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39234.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38103.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":34595.43,"10th_percentile":34595.43,"90th_percentile":34595.43,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":63110.1,"10th_percentile":63110.1,"90th_percentile":63110.1,"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":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":18935.61,"maximum":52106.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39386.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19314.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":29303.7},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42605.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":44328.82},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33482.35},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":33482.35},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":44328.82},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18935.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":38081.64},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":52106.0},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19314.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19124.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19124.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":43149.87},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":18935.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":45068.4},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32463.12},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":45068.4},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19124.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19882.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19693.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19124.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":17178.98,"10th_percentile":17178.98,"90th_percentile":17178.98,"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."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":11791.47,"10th_percentile":11791.47,"90th_percentile":11791.47,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":11927.71,"10th_percentile":11927.71,"90th_percentile":11927.71,"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."}]}]},{"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":25674.87,"maximum":71242.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":53403.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26188.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":40065.64},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":57768.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":54459.95,"10th_percentile":54459.95,"90th_percentile":54459.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":42507.1,"10th_percentile":42507.1,"90th_percentile":42507.1,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":22304.64,"10th_percentile":22304.64,"90th_percentile":22304.64,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":48344.73,"10th_percentile":48344.73,"90th_percentile":48344.73,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":22769.53,"10th_percentile":22769.53,"90th_percentile":22769.53,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":22332.77,"10th_percentile":22332.77,"90th_percentile":22332.77,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":7802.52,"10th_percentile":7802.52,"90th_percentile":7802.52,"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."}]}]},{"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":12534.6,"maximum":33930.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26071.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12785.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19081.9},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28202.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":28865.9},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21802.94},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":21802.94},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":28865.9},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12534.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":24797.89},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":33930.23},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12785.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12659.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12659.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":28098.2},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":12534.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29347.5},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21139.23},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":29347.5},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12659.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13161.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13035.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12659.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":10203.6,"10th_percentile":10203.6,"90th_percentile":10203.6},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":160.74,"10th_percentile":160.74,"90th_percentile":160.74,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9865.38,"10th_percentile":9865.38,"90th_percentile":10758.0,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17444.23,"10th_percentile":17444.23,"90th_percentile":17444.23,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":20203.34,"10th_percentile":20203.34,"90th_percentile":20203.34},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":6231.45,"10th_percentile":6231.45,"90th_percentile":6231.45,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":6231.45,"10th_percentile":6231.45,"90th_percentile":6231.45,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11646.4,"10th_percentile":11646.4,"90th_percentile":20933.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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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: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9476.28,"10th_percentile":9476.28,"90th_percentile":9476.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_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":2047.48,"10th_percentile":2047.48,"90th_percentile":2047.48,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":1581.76,"10th_percentile":1581.76,"90th_percentile":2047.48,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":2339.53,"10th_percentile":1613.4,"90th_percentile":4680.76,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13592.96,"10th_percentile":13592.96,"90th_percentile":14071.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_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":1526.17,"10th_percentile":1526.17,"90th_percentile":1526.17,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":1526.17,"10th_percentile":1526.17,"90th_percentile":2047.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":44173.66,"maximum":123769.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":91881.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45057.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":69606.44},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":99390.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":102495.88},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":44173.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":107053.05},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":77111.14},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":107053.05},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44615.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46382.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45940.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44615.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":2875.17,"10th_percentile":2079.84,"90th_percentile":41737.5,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":86651.48,"10th_percentile":86651.48,"90th_percentile":86651.48,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":38616.55,"10th_percentile":2235.12,"90th_percentile":39676.82,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":17146.0,"maximum":47024.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35663.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17488.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":26445.86},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38578.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":40005.64},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30216.98},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":30216.98},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":40005.64},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17146.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":34367.73},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":47024.36},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17488.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17317.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17317.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":38941.68},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":17146.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":40673.1},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29297.15},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":40673.1},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17317.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18003.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17831.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17317.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":863.71,"10th_percentile":863.71,"90th_percentile":1650.0,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"1 through 10","median_amount":57329.87,"10th_percentile":57329.87,"90th_percentile":57329.87},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":56778.7,"10th_percentile":56778.7,"90th_percentile":56778.7},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1092.38,"10th_percentile":1092.38,"90th_percentile":1092.38,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":15730.97,"10th_percentile":15730.97,"90th_percentile":15733.47,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":10267.8,"maximum":27493.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21357.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10473.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15462.04},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23102.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":23390.01},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17666.9},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":17666.9},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":23390.01},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10267.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":20093.7},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":27493.63},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10473.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10370.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10370.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22767.94},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":10267.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23780.25},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17129.1},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":23780.25},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10370.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10781.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10678.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10370.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":638.68,"10th_percentile":638.68,"90th_percentile":638.68,"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":"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":38730.18,"maximum":108312.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":80558.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39504.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":60913.72},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":87142.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":92146.47},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":69599.89},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":69599.89},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":92146.47},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38730.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":79160.45},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":108312.94},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39504.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39117.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39117.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":17158.7,"maximum":47060.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35690.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17501.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":26466.14},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38607.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":12049.48,"maximum":32552.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25062.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12290.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18307.21},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27111.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":27694.0},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20917.78},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":20917.78},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":27694.0},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12049.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":23791.14},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":32552.73},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12290.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12169.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12169.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26957.47},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":12049.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":28156.05},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20281.02},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":28156.05},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12169.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12651.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12531.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12169.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":26269.55,"maximum":72930.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":54640.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26794.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":41015.3},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":59106.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":12154.59,"10th_percentile":1494.95,"90th_percentile":23548.54,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":8261.55,"10th_percentile":8261.55,"90th_percentile":8261.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1289.56,"10th_percentile":1289.56,"90th_percentile":1289.56,"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."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Cc","code_information":[{"code":"841","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13538.18,"maximum":36779.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28159.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13808.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":20684.52},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30460.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":11385.48,"10th_percentile":11385.48,"90th_percentile":11385.48,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":4001.76,"10th_percentile":634.07,"90th_percentile":11653.81,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":3393.37,"10th_percentile":3393.37,"90th_percentile":3393.37,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28517.22,"10th_percentile":28517.22,"90th_percentile":28517.22,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":11640.39,"10th_percentile":590.02,"90th_percentile":11669.37,"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."}]}]},{"description":"Lymphoma And Non-Acute Leukemia Without Cc/Mcc","code_information":[{"code":"842","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8607.6,"maximum":22779.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17903.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8779.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12810.86},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19367.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":19379.47},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14637.66},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":14637.66},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":19379.47},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8607.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":16648.36},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":22779.47},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8779.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8693.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8693.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18864.07},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":8607.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19702.8},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14192.08},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":19702.8},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8693.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9037.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8951.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8693.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":13240.0,"10th_percentile":13240.0,"90th_percentile":13240.0,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":7551.84,"10th_percentile":7551.84,"90th_percentile":7551.84,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":16423.48,"maximum":44972.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34160.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16751.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":25292.07},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36952.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":81875.95,"10th_percentile":81875.95,"90th_percentile":81875.95},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34331.9,"10th_percentile":34331.9,"90th_percentile":34331.9,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":13907.26,"10th_percentile":13907.26,"90th_percentile":13907.26,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":26256.91,"10th_percentile":26256.91,"90th_percentile":26256.91,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":10251.13,"maximum":27446.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21322.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10456.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15435.41},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23065.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":23349.73},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17636.47},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":17636.47},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":23349.73},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10251.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":20059.1},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":27446.28},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10456.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10353.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10353.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22728.74},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":10251.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23739.3},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17099.6},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":23739.3},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10353.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10763.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10661.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10353.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":637.58,"10th_percentile":637.58,"90th_percentile":637.58,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":23892.03,"10th_percentile":23892.03,"90th_percentile":23892.03,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":2744.55,"10th_percentile":2744.55,"90th_percentile":2744.55,"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."}]}]},{"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":7346.77,"maximum":19199.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15281.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7493.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10797.44},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16530.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":16333.69},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12337.13},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":12337.13},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":16333.69},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7346.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":14031.81},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":19199.32},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7493.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7420.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7420.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15899.29},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":7346.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16606.2},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11961.57},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":16606.2},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7420.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7714.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7640.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7420.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1532.13,"10th_percentile":1532.13,"90th_percentile":7999.67,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":21169.06,"maximum":58447.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44031.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21592.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":32870.31},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":47630.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":49724.15},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37557.55},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":37557.55},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":49724.15},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21169.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":42716.62},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":58447.91},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21592.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21380.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21380.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":18545.25,"10th_percentile":960.96,"90th_percentile":20011.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16111.21,"10th_percentile":16111.21,"90th_percentile":21308.17,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":28920.41,"10th_percentile":28920.41,"90th_percentile":28920.41},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":15396.06,"10th_percentile":15396.06,"90th_percentile":15396.06,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":17515.33,"10th_percentile":5153.2,"90th_percentile":17515.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":29782.24,"10th_percentile":9483.92,"90th_percentile":34796.68},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":9492.24,"10th_percentile":478.14,"90th_percentile":9815.56,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":3687.33,"10th_percentile":3593.23,"90th_percentile":3687.33,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":8137.75,"10th_percentile":478.14,"90th_percentile":8137.75,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":9508.46,"10th_percentile":9508.46,"90th_percentile":9508.46,"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."}]}]},{"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":7329.3,"maximum":19149.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15244.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7475.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10769.54},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16490.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":22098.01,"maximum":61085.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45963.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22539.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":34353.75},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":49720.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":51968.21},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39252.53},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":39252.53},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":51968.21},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22098.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":44644.43},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":61085.68},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22539.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22318.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22318.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":50586.09},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":22098.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":52835.25},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38057.64},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":52835.25},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22318.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23202.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22981.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22318.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":69339.46,"maximum":195228.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":144226.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70726.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":109793.8},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":156013.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":166089.21},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":125450.18},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":125450.18},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":166089.21},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69339.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":142682.58},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":195228.43},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70726.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70032.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70032.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":161672.0},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":69339.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":168860.25},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":121631.34},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":168860.25},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70032.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72806.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72113.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70032.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":66513.99,"10th_percentile":66513.99,"90th_percentile":66513.99,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":3466.3,"10th_percentile":3466.3,"90th_percentile":89794.8,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":39796.48,"maximum":111340.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":82776.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40592.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":62616.51},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":89542.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":94722.35},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":71545.5},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":71545.5},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":94722.35},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39796.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":81373.31},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":111340.74},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40592.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40194.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40194.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":92203.17},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":39796.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":96302.7},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":69367.58},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":96302.7},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40194.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41786.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41388.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40194.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":55855.09,"10th_percentile":3498.0,"90th_percentile":79786.43,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"38","median_amount":2586.45,"10th_percentile":1764.29,"90th_percentile":39877.26,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33885.43,"10th_percentile":33885.43,"90th_percentile":46679.9,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":61036.36,"10th_percentile":61036.36,"90th_percentile":147603.61},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":87323.92,"10th_percentile":87279.32,"90th_percentile":88258.21,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":95423.63,"10th_percentile":95423.63,"90th_percentile":541664.98,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":68282.47,"10th_percentile":62937.92,"90th_percentile":85056.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":106536.31,"10th_percentile":106536.31,"90th_percentile":106536.31,"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":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":34365.3,"10th_percentile":1881.91,"90th_percentile":36106.3,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":78635.06,"10th_percentile":77349.17,"90th_percentile":139827.22,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"1 through 10","median_amount":829.83,"10th_percentile":829.83,"90th_percentile":829.83},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"39","median_amount":3606.5,"10th_percentile":1764.29,"90th_percentile":38460.03,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":9662.83,"10th_percentile":9662.83,"90th_percentile":9662.83,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":8856.91,"10th_percentile":8856.91,"90th_percentile":35995.99,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":90958.64,"10th_percentile":48339.49,"90th_percentile":97525.35,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":69367.58,"10th_percentile":69367.58,"90th_percentile":69367.58,"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":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"49","median_amount":2022.42,"10th_percentile":1668.77,"90th_percentile":36637.12,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"1 through 10","median_amount":2586.45,"10th_percentile":2586.45,"90th_percentile":2586.45,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"13","median_amount":1881.91,"10th_percentile":1474.74,"90th_percentile":30340.79,"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."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":825.0,"10th_percentile":751.86,"90th_percentile":14821.99,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4300.07,"10th_percentile":4300.07,"90th_percentile":4300.07,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":40960.24,"10th_percentile":40960.24,"90th_percentile":40960.24},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":35345.48,"10th_percentile":35253.65,"90th_percentile":35795.14,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19862.1,"10th_percentile":19862.1,"90th_percentile":19862.1,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18398.0,"10th_percentile":18398.0,"90th_percentile":25812.81,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":1046.44,"10th_percentile":751.86,"90th_percentile":15069.98,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31324.21,"10th_percentile":28588.79,"90th_percentile":41526.9,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":73028.21,"10th_percentile":62408.87,"90th_percentile":73028.21},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_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":751.86,"10th_percentile":751.86,"90th_percentile":751.86,"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":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":2135.0,"10th_percentile":751.86,"90th_percentile":14719.1,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":9662.83,"10th_percentile":9662.83,"90th_percentile":9662.83,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38377.44,"10th_percentile":38377.44,"90th_percentile":38377.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1046.44,"10th_percentile":1046.44,"90th_percentile":15410.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29564.79,"10th_percentile":29564.79,"90th_percentile":29564.79,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":36700.78,"maximum":102550.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":76337.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37434.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":57672.97},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":82576.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":87244.07},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":65897.02},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":65897.02},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":87244.07},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36700.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":74948.93},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":102550.44},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37434.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37067.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37067.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":84923.77},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":36700.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":88699.65},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":63891.04},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":88699.65},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37067.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38535.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38168.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37067.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":67423.18,"10th_percentile":67423.18,"90th_percentile":67423.18,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":4972.21,"10th_percentile":1697.64,"90th_percentile":33115.87,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":88526.3,"10th_percentile":88526.3,"90th_percentile":88526.3,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":66383.73,"10th_percentile":66383.73,"90th_percentile":66383.73,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":32787.25,"10th_percentile":2382.25,"90th_percentile":36098.75,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":32797.74,"10th_percentile":32797.74,"90th_percentile":32797.74,"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."}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":881.1,"10th_percentile":819.89,"90th_percentile":17979.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":39740.96,"10th_percentile":39740.96,"90th_percentile":39740.96,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":8340.17,"10th_percentile":819.89,"90th_percentile":14212.93,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":51528.57,"10th_percentile":51528.57,"90th_percentile":51528.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":9901.28,"10th_percentile":9901.28,"90th_percentile":9901.28,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2860.9,"10th_percentile":2860.9,"90th_percentile":2860.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":9672.08,"10th_percentile":9672.08,"90th_percentile":9672.08,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17484.88,"10th_percentile":17484.88,"90th_percentile":17484.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"1 through 10","median_amount":10237.46,"10th_percentile":10237.46,"90th_percentile":10237.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":15064.99,"maximum":41115.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31335.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15366.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":23122.69},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33896.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":34978.57},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26419.94},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":26419.94},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":34978.57},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15064.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":30049.1},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":41115.32},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15366.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15215.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15215.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":32932.64,"10th_percentile":32932.64,"90th_percentile":33625.24,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33536.05,"10th_percentile":33536.05,"90th_percentile":33536.05,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26615.08,"10th_percentile":25344.64,"90th_percentile":54311.59,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29896.41,"10th_percentile":29896.41,"90th_percentile":29896.41,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":30466.77,"10th_percentile":30466.77,"90th_percentile":30466.77},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":6732.38,"10th_percentile":743.53,"90th_percentile":7558.82,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_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":3098.61,"10th_percentile":3098.61,"90th_percentile":3098.61,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":8816.29,"10th_percentile":8816.29,"90th_percentile":8816.29,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1402.0,"10th_percentile":1402.0,"90th_percentile":1402.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":691.88,"10th_percentile":583.15,"90th_percentile":20237.44,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":780.0,"10th_percentile":780.0,"90th_percentile":780.0,"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":"Postoperative And Post-Traumatic Infections Without Mcc","code_information":[{"code":"863","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8508.36,"maximum":22497.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17697.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8678.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12652.37},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19143.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":19139.72},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14456.58},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":14456.58},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":19139.72},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8508.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":16442.4},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":22497.66},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8678.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8593.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8593.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18630.69},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":8508.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19459.05},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14016.5},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":19459.05},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8593.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8933.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8848.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8593.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":15918.59,"10th_percentile":15918.59,"90th_percentile":15918.59,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":7902.9,"10th_percentile":522.62,"90th_percentile":9801.9,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":18201.31,"10th_percentile":18201.31,"90th_percentile":18201.31,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15675.43,"10th_percentile":15675.43,"90th_percentile":15675.43,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":39287.8,"10th_percentile":13782.62,"90th_percentile":54099.59,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":7458.31,"10th_percentile":7458.31,"90th_percentile":7458.31,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15675.43,"10th_percentile":15675.43,"90th_percentile":15675.43,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":39988.1,"10th_percentile":39988.1,"90th_percentile":39988.1},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":2252.86,"10th_percentile":522.62,"90th_percentile":8006.19,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18185.18,"10th_percentile":18185.18,"90th_percentile":18185.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":6075.38,"10th_percentile":404.34,"90th_percentile":7992.09,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":7633.4,"maximum":20013.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15877.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7786.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11255.15},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17175.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":363.13,"10th_percentile":363.13,"90th_percentile":7799.23,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14734.93,"10th_percentile":14734.93,"90th_percentile":14734.93,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":14718.34,"10th_percentile":14718.34,"90th_percentile":14718.34},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":363.13,"10th_percentile":337.9,"90th_percentile":6859.3,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":1653.19,"10th_percentile":1653.19,"90th_percentile":1653.19,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17310.15,"10th_percentile":17310.15,"90th_percentile":17310.15,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":464.91,"10th_percentile":350.0,"90th_percentile":7168.31,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"1 through 10","median_amount":7251.62,"10th_percentile":7251.62,"90th_percentile":7251.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":6792.12,"10th_percentile":6792.12,"90th_percentile":6792.12,"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":"Viral Illness With Mcc","code_information":[{"code":"865","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12481.4,"maximum":33779.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25961.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12731.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18996.95},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28083.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":28737.39},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21705.87},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":21705.87},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":28737.39},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12481.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":24687.49},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":33779.17},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12731.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12606.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12606.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":27973.11},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":12481.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29216.85},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21045.12},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":29216.85},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12606.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13105.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12980.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12606.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":8076.4,"10th_percentile":8076.4,"90th_percentile":8076.4},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":10452.83,"10th_percentile":10452.83,"90th_percentile":10452.83,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23137.68,"10th_percentile":23137.68,"90th_percentile":23137.68,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":10981.09,"10th_percentile":784.7,"90th_percentile":20329.86,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":10999.53,"10th_percentile":10999.53,"90th_percentile":10999.53,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":7489.69,"maximum":19605.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15578.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7639.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11025.66},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16851.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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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: 102% of Medicare]","count":"1 through 10","median_amount":455.43,"10th_percentile":455.43,"90th_percentile":455.43,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":17375.38,"10th_percentile":17375.38,"90th_percentile":17375.38,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10582.58,"10th_percentile":10582.58,"90th_percentile":10582.58,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13131.18,"10th_percentile":13131.18,"90th_percentile":13131.18,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":6743.13,"10th_percentile":6743.13,"90th_percentile":6743.13},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":1606.82,"10th_percentile":1606.82,"90th_percentile":9036.55,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16091.86,"10th_percentile":16091.86,"90th_percentile":17253.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12007.62,"10th_percentile":12007.62,"90th_percentile":12007.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":5016.46,"10th_percentile":5016.46,"90th_percentile":5016.46,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":17204.75,"maximum":47191.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35785.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17548.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":26539.68},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38710.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29557.03,"10th_percentile":29557.03,"90th_percentile":45938.75,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":8771.95,"maximum":23246.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18245.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8947.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13073.32},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19736.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":19776.5},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14937.55},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":14937.55},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":19776.5},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8771.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":16989.43},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":23246.15},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8947.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8859.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8859.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19250.53},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":8771.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20106.45},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14482.83},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":20106.45},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8859.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9210.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9122.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8859.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":6107.6,"10th_percentile":6107.6,"90th_percentile":6107.6,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19098.17,"10th_percentile":19098.17,"90th_percentile":19098.17,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":6378.92,"maximum":16451.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13268.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6506.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9251.87},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14352.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":13995.65},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10571.16},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":10571.16},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":13995.65},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6378.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":12023.27},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":16451.09},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6506.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6442.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6442.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13623.43},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":6378.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14229.15},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10249.37},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":14229.15},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6442.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6697.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6634.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6442.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":2348.76,"10th_percentile":2348.76,"90th_percentile":2348.76,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":55463.18,"maximum":155826.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":115363.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56572.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":87634.71},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":124792.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":129042.61},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":55463.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":134780.1},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":97083.14},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":134780.1},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56017.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58236.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57681.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56017.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":122400.61,"10th_percentile":122400.61,"90th_percentile":122400.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1636.02,"10th_percentile":1636.02,"90th_percentile":31533.77,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":24419.0,"10th_percentile":24419.0,"90th_percentile":24419.0,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":26676.23,"10th_percentile":1840.45,"90th_percentile":74050.5,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":16008.23,"maximum":43793.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33297.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16328.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":24628.96},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36018.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"161","median_amount":1017.33,"10th_percentile":738.31,"90th_percentile":15179.09,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22966.67,"10th_percentile":10108.97,"90th_percentile":24877.47,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"1 through 10","median_amount":41954.92,"10th_percentile":36422.11,"90th_percentile":190783.7},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":53122.1,"10th_percentile":36033.88,"90th_percentile":95348.47},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"15","median_amount":35161.92,"10th_percentile":28590.73,"90th_percentile":36171.14,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":35536.74,"10th_percentile":30759.84,"90th_percentile":35786.74,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"23","median_amount":25770.59,"10th_percentile":21524.12,"90th_percentile":28348.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":42065.46,"10th_percentile":42065.46,"90th_percentile":42065.46,"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":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26870.0,"10th_percentile":26870.0,"90th_percentile":26870.0,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"59","median_amount":5363.12,"10th_percentile":738.31,"90th_percentile":14880.0,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":30759.84,"10th_percentile":25267.24,"90th_percentile":64039.55,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":44265.17,"10th_percentile":16703.33,"90th_percentile":101531.14},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"1 through 10","median_amount":72102.04,"10th_percentile":72102.04,"90th_percentile":72102.04},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_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":793.43,"10th_percentile":738.31,"90th_percentile":1017.33,"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":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"1 through 10","median_amount":9742.6,"10th_percentile":9742.6,"90th_percentile":9742.6,"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":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":14510.51,"10th_percentile":14510.51,"90th_percentile":14510.51,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"184","median_amount":1017.33,"10th_percentile":738.31,"90th_percentile":14641.58,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":5518.96,"10th_percentile":4519.22,"90th_percentile":10439.4,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"12","median_amount":8856.91,"10th_percentile":4519.22,"90th_percentile":10439.4,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35684.71,"10th_percentile":7691.68,"90th_percentile":38260.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26627.66,"10th_percentile":25275.72,"90th_percentile":26627.66,"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":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35684.71,"10th_percentile":35684.71,"90th_percentile":35684.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"191","median_amount":1017.33,"10th_percentile":738.31,"90th_percentile":14505.31,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"1 through 10","median_amount":738.31,"10th_percentile":738.31,"90th_percentile":14391.21,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"90","median_amount":1017.33,"10th_percentile":738.31,"90th_percentile":14504.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"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":8710.02,"maximum":23070.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18116.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8884.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12974.42},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19597.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":19626.89},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14824.55},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":14824.55},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":19626.89},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8710.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":16860.91},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":23070.3},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8884.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8797.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8797.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19104.91},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":8710.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19954.35},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14373.27},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":19954.35},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8797.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9145.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9058.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8797.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":16387.76,"10th_percentile":16229.95,"90th_percentile":17178.82,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"1 through 10","median_amount":4533.77,"10th_percentile":4533.77,"90th_percentile":4533.77,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"42","median_amount":535.92,"10th_percentile":387.95,"90th_percentile":7900.94,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33501.0,"10th_percentile":33501.0,"90th_percentile":33501.0,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"1 through 10","median_amount":15593.66,"10th_percentile":15593.66,"90th_percentile":15593.66},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":9164.05,"10th_percentile":9164.05,"90th_percentile":9164.05},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"14","median_amount":18835.38,"10th_percentile":14801.78,"90th_percentile":19170.41,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18804.41,"10th_percentile":18804.41,"90th_percentile":18804.41,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":12557.1,"10th_percentile":8211.3,"90th_percentile":14211.3,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"17","median_amount":5953.01,"10th_percentile":387.95,"90th_percentile":7752.67,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"15","median_amount":13759.92,"10th_percentile":12739.0,"90th_percentile":16162.99,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":31458.83,"10th_percentile":25153.29,"90th_percentile":80668.36},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":7798.37,"10th_percentile":387.95,"90th_percentile":7818.23,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"55","median_amount":416.91,"10th_percentile":332.51,"90th_percentile":7797.42,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":15174.08,"10th_percentile":15174.08,"90th_percentile":15174.08},{"payer_name":"Molina","plan_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":2895.87,"10th_percentile":2895.87,"90th_percentile":2895.87,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":4519.22,"10th_percentile":2348.76,"90th_percentile":21124.83,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":4401.72,"10th_percentile":3471.36,"90th_percentile":10439.4,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14860.6,"10th_percentile":2597.0,"90th_percentile":19954.35,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8635.18,"10th_percentile":8635.18,"90th_percentile":8635.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"66","median_amount":416.91,"10th_percentile":315.23,"90th_percentile":7802.92,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"1 through 10","median_amount":535.92,"10th_percentile":535.92,"90th_percentile":535.92,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"14","median_amount":535.92,"10th_percentile":387.95,"90th_percentile":7812.37,"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."}]}]},{"description":"O.R. 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":8209.03,"maximum":21647.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17074.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8373.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12174.38},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18470.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":17591.24,"10th_percentile":17591.24,"90th_percentile":17591.24,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11438.34,"10th_percentile":11438.34,"90th_percentile":11438.34,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15888.36,"10th_percentile":15888.36,"90th_percentile":15888.36,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":102439.57,"10th_percentile":102439.57,"90th_percentile":102439.57},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":360.71,"10th_percentile":360.71,"90th_percentile":7353.58,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":24996.83,"10th_percentile":24996.83,"90th_percentile":24996.83},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":387.64,"10th_percentile":387.64,"90th_percentile":7278.58,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":360.71,"10th_percentile":360.71,"90th_percentile":7302.66,"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":"Depressive Neuroses","code_information":[{"code":"881","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8055.79,"maximum":21212.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16756.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8216.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11929.67},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18125.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":18046.46},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13630.82},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":13630.82},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":18046.46},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8055.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":15503.21},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":21212.59},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8216.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8136.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8136.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17566.51},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":8055.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18347.55},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13215.88},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":18347.55},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8136.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8458.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8378.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8136.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14280.35,"10th_percentile":14280.35,"90th_percentile":14280.35,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":9110.98,"maximum":24208.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18950.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9293.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13614.71},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20499.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":20595.48},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15556.14},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":15556.14},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":20595.48},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9110.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":17693.0},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":24208.82},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9293.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9202.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9202.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20047.74},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":9110.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20939.1},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15082.59},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":20939.1},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9202.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9566.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9475.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9202.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13260.21,"10th_percentile":13260.21,"90th_percentile":13260.21,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":16197.2,"maximum":44330.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33690.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16521.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":24930.72},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36443.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":37713.63},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28485.79},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":28485.79},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":37713.63},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16197.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":32398.73},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":44330.23},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16521.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16359.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16359.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":36710.62},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":16197.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":38342.85},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27618.65},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":38342.85},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16359.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17007.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16845.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16359.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28696.18,"10th_percentile":28696.18,"90th_percentile":28696.18,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":13359.54,"maximum":36272.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27787.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13626.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":20399.24},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30058.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16917.16,"10th_percentile":16917.16,"90th_percentile":22319.0,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":628.47,"10th_percentile":193.0,"90th_percentile":11720.26,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"16","median_amount":842.61,"10th_percentile":628.47,"90th_percentile":12496.54,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":5077.11,"10th_percentile":5077.11,"90th_percentile":5077.11,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1165.22,"10th_percentile":1165.22,"90th_percentile":1165.22,"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":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"22","median_amount":675.4,"10th_percentile":431.1,"90th_percentile":12277.32,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":675.4,"10th_percentile":628.47,"90th_percentile":12411.5,"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":"Psychoses","code_information":[{"code":"885","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11675.52,"maximum":31490.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24285.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11909.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17710.03},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26269.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":26790.62},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20235.44},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":20235.44},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":26790.62},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11675.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":23015.07},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":31490.86},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11909.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11792.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11792.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26078.12},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":11675.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":27237.6},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19619.45},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":27237.6},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11792.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12259.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12142.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11792.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":1531.44,"10th_percentile":1531.44,"90th_percentile":1531.44,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":731.53,"10th_percentile":731.53,"90th_percentile":731.53,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":12511.73,"10th_percentile":12511.73,"90th_percentile":12511.73},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":25776.38,"10th_percentile":25776.38,"90th_percentile":25776.38,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17454.51,"10th_percentile":17454.51,"90th_percentile":17454.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18789.79,"10th_percentile":17629.93,"90th_percentile":35546.0,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17265.55,"10th_percentile":17265.55,"90th_percentile":17265.55,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"1 through 10","median_amount":4148.38,"10th_percentile":4148.38,"90th_percentile":4148.38},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"1 through 10","median_amount":921.69,"10th_percentile":921.69,"90th_percentile":921.69,"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":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":570.01,"10th_percentile":530.42,"90th_percentile":10521.17,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":863.17,"10th_percentile":863.17,"90th_percentile":863.17,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":570.01,"10th_percentile":277.61,"90th_percentile":10346.85,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":10523.52,"10th_percentile":10523.52,"90th_percentile":10523.52,"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."}]}]},{"description":"Behavioral And Developmental Disorders","code_information":[{"code":"886","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17062.63,"maximum":46787.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35490.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17403.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":26312.73},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38390.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":38745.64},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":17062.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":40468.35},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29149.66},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":40468.35},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17233.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17915.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17745.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17233.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":32003.03,"10th_percentile":32003.03,"90th_percentile":32003.03,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":9087.96,"maximum":24143.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18902.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9269.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13577.94},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20447.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":20539.86},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15514.13},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":15514.13},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":20539.86},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9087.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":17645.22},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":24143.44},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9269.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9178.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9178.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19993.6},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":9087.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20882.55},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15041.86},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":20882.55},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9178.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9542.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9451.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9178.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14963.46,"10th_percentile":14963.46,"90th_percentile":14963.46,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":5483.31,"maximum":13908.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11405.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5592.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":7821.68},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12337.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":11832.14},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8937.03},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":8937.03},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":11832.14},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5483.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":10164.66},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":13908.01},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5592.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5538.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5538.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":252.37,"10th_percentile":234.84,"90th_percentile":5844.84,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":11843.17,"10th_percentile":11734.4,"90th_percentile":12694.39,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9784.02,"10th_percentile":9675.59,"90th_percentile":10239.92,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8602.59,"10th_percentile":7347.09,"90th_percentile":8602.59,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":4848.48,"10th_percentile":4848.48,"90th_percentile":4848.48,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9784.02,"10th_percentile":9784.02,"90th_percentile":10239.92,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"1 through 10","median_amount":16549.0,"10th_percentile":16549.0,"90th_percentile":16549.0},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_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":323.09,"10th_percentile":323.09,"90th_percentile":323.09,"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":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":234.84,"10th_percentile":234.84,"90th_percentile":323.09,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":1063.66,"10th_percentile":1063.66,"90th_percentile":1566.2,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8469.66,"10th_percentile":8469.66,"90th_percentile":21801.44,"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":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":3301.39,"10th_percentile":234.84,"90th_percentile":4880.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":8038.08,"10th_percentile":670.08,"90th_percentile":15230.57,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22578.76,"10th_percentile":22578.76,"90th_percentile":22578.76,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":32046.41,"10th_percentile":31650.95,"90th_percentile":32964.5,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32480.01,"10th_percentile":30686.21,"90th_percentile":38178.57,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24546.55,"10th_percentile":24546.55,"90th_percentile":25467.99,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24546.55,"10th_percentile":24546.55,"90th_percentile":24546.55,"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":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24546.55,"10th_percentile":24546.55,"90th_percentile":27917.6,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":72824.91,"10th_percentile":72824.91,"90th_percentile":72824.91},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"11","median_amount":1000.0,"10th_percentile":720.11,"90th_percentile":13530.52,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":4194.38,"10th_percentile":4194.38,"90th_percentile":4194.38,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33023.41,"10th_percentile":33023.41,"90th_percentile":34725.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25013.12,"10th_percentile":25013.12,"90th_percentile":25013.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"11","median_amount":720.11,"10th_percentile":670.08,"90th_percentile":13076.68,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":5983.86,"10th_percentile":670.08,"90th_percentile":13230.55,"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."}]}]},{"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":7594.49,"maximum":19902.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15796.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7746.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11193.02},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17087.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":16932.1},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12789.12},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":12789.12},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":16932.1},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7594.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":14545.9},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":19902.73},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7746.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7670.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7670.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16481.79},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":7594.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17214.6},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12399.81},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":17214.6},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7670.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7974.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7898.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7670.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"12","median_amount":14142.84,"10th_percentile":1531.44,"90th_percentile":14987.29,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"42","median_amount":331.96,"10th_percentile":331.96,"90th_percentile":7128.23,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11185.41,"10th_percentile":10701.0,"90th_percentile":14142.84,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"1 through 10","median_amount":11982.54,"10th_percentile":11982.54,"90th_percentile":11982.54},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":14376.35,"10th_percentile":12739.36,"90th_percentile":27826.51},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"43","median_amount":16387.18,"10th_percentile":16152.55,"90th_percentile":18067.68,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"22","median_amount":15332.84,"10th_percentile":12028.49,"90th_percentile":16090.45,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"59","median_amount":12160.24,"10th_percentile":9160.24,"90th_percentile":12883.58,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5304.29,"10th_percentile":5304.29,"90th_percentile":9105.0,"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":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"17","median_amount":331.96,"10th_percentile":301.78,"90th_percentile":6525.65,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"32","median_amount":13830.25,"10th_percentile":11064.2,"90th_percentile":14653.6,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":19721.25,"10th_percentile":13126.93,"90th_percentile":82463.48},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"1 through 10","median_amount":17861.79,"10th_percentile":17861.79,"90th_percentile":22111.83},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_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":331.96,"10th_percentile":331.96,"90th_percentile":331.96,"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":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"49","median_amount":356.74,"10th_percentile":301.78,"90th_percentile":6734.5,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_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":2056.15,"10th_percentile":2056.15,"90th_percentile":2056.15,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":2056.15,"10th_percentile":2056.15,"90th_percentile":2056.15,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":2056.15,"10th_percentile":2056.15,"90th_percentile":4194.38,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"20","median_amount":16044.57,"10th_percentile":4805.01,"90th_percentile":17748.57,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"15","median_amount":10834.56,"10th_percentile":8972.34,"90th_percentile":12391.38,"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":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"33","median_amount":462.34,"10th_percentile":301.78,"90th_percentile":6735.09,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"1 through 10","median_amount":2312.8,"10th_percentile":2312.8,"90th_percentile":2312.8,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":356.74,"10th_percentile":331.96,"90th_percentile":6751.08,"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."}]}]},{"description":"Wound Debridements For Injuries With Mcc","code_information":[{"code":"901","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33905.2,"maximum":94612.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":70522.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34583.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":53208.69},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":76286.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":80490.79},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":60796.14},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":60796.14},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":80490.79},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33905.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":69147.38},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":94612.35},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34583.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34244.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34244.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":78350.1},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":33905.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":81833.7},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":58945.44},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":81833.7},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34244.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35600.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35261.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34244.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":15785.92,"maximum":43162.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32834.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16101.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":24273.95},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35518.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":36720.11},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27735.36},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":27735.36},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":36720.11},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15785.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":31545.22},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":43162.4},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16101.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15943.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15943.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":35743.52},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":15785.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":37332.75},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26891.07},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":37332.75},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15943.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16575.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16417.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15943.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":33974.64,"10th_percentile":33974.64,"90th_percentile":33974.64,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1002.67,"10th_percentile":1002.67,"90th_percentile":14011.7,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":714.04,"10th_percentile":714.04,"90th_percentile":14003.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Wound Debridements For Injuries Without Cc/Mcc","code_information":[{"code":"903","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9871.61,"maximum":26368.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20532.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10069.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14829.36},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22211.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":22432.93},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16944.0},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":16944.0},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":22432.93},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9871.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":19271.5},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":26368.63},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10069.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9970.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9970.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21836.32},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":9871.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22807.2},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16428.2},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":22807.2},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9970.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10365.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10266.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9970.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22171.77,"10th_percentile":22171.77,"90th_percentile":22171.77,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":29748.75,"maximum":82810.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":61877.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30343.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":46571.23},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":66934.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":70450.06},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":53212.2},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":53212.2},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":70450.06},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29748.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":60521.67},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":82810.04},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30343.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30046.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30046.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":68576.41},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":29748.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":71625.45},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":51592.36},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":71625.45},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30046.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31236.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30938.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30046.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":12363.1,"maximum":33443.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25715.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12610.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18808.03},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27816.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":28451.61},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21490.02},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":21490.02},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":28451.61},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12363.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":24441.98},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":33443.25},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12610.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12486.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12486.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":27694.93},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":12363.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":28926.3},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20835.84},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":28926.3},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12486.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12981.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12857.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12486.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":16181.32,"maximum":44285.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33657.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16504.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":24905.36},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36407.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":37675.27},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28456.81},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":28456.81},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":37675.27},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16181.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":32365.77},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":44285.14},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16504.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16343.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16343.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":36673.28},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":16181.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":38303.85},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27590.56},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":38303.85},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16343.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16990.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16828.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16343.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1028.75,"10th_percentile":1028.75,"90th_percentile":1028.75,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":31068.33,"maximum":86557.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":64622.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31689.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":48678.48},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":69903.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":73637.77},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":55619.94},{"payer_name":"Blue Cross","plan_name":"Health Options - 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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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":105188.21,"10th_percentile":105188.21,"90th_percentile":105188.21,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":16918.39,"10th_percentile":1303.54,"90th_percentile":35448.3,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":2010.72,"10th_percentile":1499.01,"90th_percentile":35739.45,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":28707.02,"10th_percentile":1610.92,"90th_percentile":29020.6,"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."}]}]},{"description":"Other O.R. 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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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38551.25,"10th_percentile":38551.25,"90th_percentile":38551.25,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27803.71,"10th_percentile":27803.71,"90th_percentile":27803.71,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34365.72,"10th_percentile":34365.72,"90th_percentile":34365.72,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":16939.2,"10th_percentile":16939.2,"90th_percentile":16939.2,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":2288.37,"10th_percentile":2288.37,"90th_percentile":2288.37,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36685.0,"10th_percentile":36685.0,"90th_percentile":36685.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":15031.76,"10th_percentile":8231.6,"90th_percentile":16031.13,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1050.0,"10th_percentile":1050.0,"90th_percentile":1050.0,"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":"Other O.R. Procedures For Injuries Without Cc/Mcc","code_information":[{"code":"909","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11007.79,"maximum":29594.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22896.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11227.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16643.72},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24767.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":25177.59},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19017.08},{"payer_name":"Blue Cross","plan_name":"Health Options - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":246.06,"10th_percentile":246.06,"90th_percentile":246.06,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":10577.77,"10th_percentile":10577.77,"90th_percentile":10577.77,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":262.16,"10th_percentile":262.16,"90th_percentile":262.16,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":13563.59,"maximum":36852.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28212.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13834.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":20725.09},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30518.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":31351.63},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23680.45},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":23680.45},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":31351.63},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13563.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":26933.3},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":36852.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13834.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13699.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13699.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":30517.82},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":13563.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":31874.7},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22959.59},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":31874.7},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13699.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14241.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14106.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13699.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":7615.93,"maximum":19963.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15841.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7768.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11227.25},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17135.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":16983.89},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12828.24},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":12828.24},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":16983.89},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7615.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":14590.38},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":19963.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7768.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7692.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7692.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16532.2},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":7615.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17267.25},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12437.73},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":17267.25},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7692.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7996.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7920.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7692.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1541.3,"10th_percentile":1541.3,"90th_percentile":1541.3,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":5537.98,"10th_percentile":5537.98,"90th_percentile":5537.98,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":13936.75,"maximum":37911.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28988.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14215.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":21321.01},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31357.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":32253.09},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24361.34},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":24361.34},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":32253.09},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13936.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":27707.72},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":37911.67},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14215.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14076.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14076.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":31395.3},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":13936.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":32791.2},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23619.75},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":32791.2},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14076.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14633.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14494.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14076.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":1400.0,"10th_percentile":653.94,"90th_percentile":12946.95,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":32165.91,"10th_percentile":32165.91,"90th_percentile":32165.91,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18027.52,"10th_percentile":18027.52,"90th_percentile":18027.52,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17898.76,"10th_percentile":17898.76,"90th_percentile":17898.76,"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":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26345.06,"10th_percentile":26345.06,"90th_percentile":26345.06,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":702.77,"10th_percentile":702.77,"90th_percentile":12746.95,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":5875.54,"maximum":15021.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12221.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5993.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8448.02},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13219.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8448.02,"10th_percentile":8448.02,"90th_percentile":8448.02,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":5887.26,"10th_percentile":5887.26,"90th_percentile":5887.26},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":12426.62,"10th_percentile":12426.62,"90th_percentile":12426.62,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11653.46,"10th_percentile":11653.46,"90th_percentile":11653.46,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36326.95,"10th_percentile":36326.95,"90th_percentile":36326.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9153.95,"10th_percentile":9153.95,"90th_percentile":9153.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":4973.97,"10th_percentile":4973.97,"90th_percentile":4973.97,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":249.89,"10th_percentile":249.89,"90th_percentile":249.89,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1168.0,"10th_percentile":249.89,"90th_percentile":5170.13,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"1 through 10","median_amount":5042.3,"10th_percentile":5042.3,"90th_percentile":5042.3,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":13037.98,"maximum":35359.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27119.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13298.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19885.74},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29335.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25611.22,"10th_percentile":25611.22,"90th_percentile":25611.22,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":23373.65,"10th_percentile":16753.07,"90th_percentile":30233.21,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20042.75,"10th_percentile":20042.75,"90th_percentile":29106.49,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19958.0,"10th_percentile":19899.92,"90th_percentile":22889.23,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":11345.63,"10th_percentile":11345.63,"90th_percentile":11345.63,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25705.58,"10th_percentile":25705.58,"90th_percentile":26033.87,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_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":617.0,"10th_percentile":617.0,"90th_percentile":617.0,"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":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"1 through 10","median_amount":8086.38,"10th_percentile":8086.38,"90th_percentile":8086.38,"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":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1808.08,"10th_percentile":487.12,"90th_percentile":12308.99,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":9054.79,"10th_percentile":9054.79,"90th_percentile":9054.79,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":7351.25,"10th_percentile":7351.25,"90th_percentile":7351.25,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30883.8,"10th_percentile":30883.8,"90th_percentile":30883.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23031.23,"10th_percentile":23031.23,"90th_percentile":23031.23,"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":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":878.0,"10th_percentile":617.0,"90th_percentile":10636.85,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"1 through 10","median_amount":11419.47,"10th_percentile":11419.47,"90th_percentile":11419.47,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":7390.44,"maximum":19323.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15372.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7538.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10867.17},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16628.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":16439.18},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12416.81},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":12416.81},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":16439.18},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7390.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":14122.44},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":19323.32},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7538.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7464.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7464.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16001.97},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":7390.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16713.45},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12038.83},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":16713.45},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7464.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7759.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7686.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7464.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":1446.48,"10th_percentile":1446.48,"90th_percentile":1446.48,"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":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":13175.8,"10th_percentile":13170.62,"90th_percentile":17262.88,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12630.87,"10th_percentile":12630.87,"90th_percentile":12630.87,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8584.01,"10th_percentile":8584.01,"90th_percentile":8584.01,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9780.25,"10th_percentile":9780.25,"90th_percentile":9780.25,"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":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12155.01,"10th_percentile":12155.01,"90th_percentile":12155.01,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":14246.78,"10th_percentile":12212.41,"90th_percentile":14377.27},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"1 through 10","median_amount":1610.92,"10th_percentile":1610.92,"90th_percentile":1610.92,"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":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":525.23,"10th_percentile":332.86,"90th_percentile":5481.78,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_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":1822.66,"10th_percentile":1822.66,"90th_percentile":1822.66,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"11","median_amount":1917.06,"10th_percentile":1267.94,"90th_percentile":3151.03,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12425.09,"10th_percentile":12425.09,"90th_percentile":12425.09,"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":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":357.71,"10th_percentile":357.71,"90th_percentile":6819.26,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1568.66,"10th_percentile":1568.66,"90th_percentile":1568.66,"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":"Complications Of Treatment With Mcc","code_information":[{"code":"919","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15121.36,"maximum":41275.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31452.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15423.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":23212.71},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34023.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":36958.2,"10th_percentile":36958.2,"90th_percentile":36958.2},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":34862.74,"10th_percentile":34862.74,"90th_percentile":34862.74,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25136.5,"10th_percentile":25136.5,"90th_percentile":25136.5,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":737.42,"10th_percentile":737.42,"90th_percentile":737.42,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24454.58,"10th_percentile":24454.58,"90th_percentile":24454.58,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":20988.0,"10th_percentile":20988.0,"90th_percentile":20988.0,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":5646.17,"10th_percentile":5646.17,"90th_percentile":5646.17,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":958.83,"10th_percentile":686.2,"90th_percentile":13813.83,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":958.83,"10th_percentile":686.2,"90th_percentile":14175.51,"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."}]}]},{"description":"Complications Of Treatment With Cc","code_information":[{"code":"920","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8543.29,"maximum":22596.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17770.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8714.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12708.16},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19222.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":19224.11},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14520.32},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":14520.32},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":19224.11},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8543.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":16514.9},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":22596.85},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8714.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8628.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8628.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18712.84},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":8543.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19544.85},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14078.31},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":19544.85},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8628.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8970.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8885.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8628.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":7766.11,"10th_percentile":7766.11,"90th_percentile":7766.11,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12708.16,"10th_percentile":12708.16,"90th_percentile":12708.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19366.44,"10th_percentile":19366.44,"90th_percentile":19366.44,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14003.17,"10th_percentile":14003.17,"90th_percentile":14003.17,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":524.93,"10th_percentile":382.27,"90th_percentile":7971.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15826.26,"10th_percentile":15160.74,"90th_percentile":15926.26,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":7697.77,"10th_percentile":7697.77,"90th_percentile":7697.77,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"11","median_amount":1616.48,"10th_percentile":382.27,"90th_percentile":8342.96,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13786.78,"10th_percentile":13786.78,"90th_percentile":13786.78,"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":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"11","median_amount":390.0,"10th_percentile":382.27,"90th_percentile":7615.98,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":524.93,"10th_percentile":382.27,"90th_percentile":8018.47,"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."}]}]},{"description":"Complications Of Treatment Without Cc/Mcc","code_information":[{"code":"921","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6051.01,"maximum":15519.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12586.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6172.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8728.22},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13614.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":13203.51},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9972.85},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":9972.85},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":13203.51},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6051.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":11342.77},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":15519.98},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6172.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6111.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6111.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12852.36},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":6051.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13423.8},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9669.27},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":13423.8},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6111.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6353.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6293.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6111.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":8126.25,"10th_percentile":258.77,"90th_percentile":10627.89,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9479.26,"10th_percentile":9479.26,"90th_percentile":9479.26,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":5282.35,"10th_percentile":278.09,"90th_percentile":5672.92,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":3295.75,"10th_percentile":258.77,"90th_percentile":5338.66,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":14475.07,"maximum":39440.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30108.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14764.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22180.64},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32568.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":11529.62,"10th_percentile":11529.62,"90th_percentile":11529.62,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":8677.32,"10th_percentile":8677.32,"90th_percentile":8677.32,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31043.12,"10th_percentile":31043.12,"90th_percentile":31043.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":8665.56,"maximum":22944.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18024.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8838.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12903.42},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19497.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12931.31,"10th_percentile":12931.31,"90th_percentile":12931.31,"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":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15554.62,"10th_percentile":15554.62,"90th_percentile":15554.62,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":4003.23,"10th_percentile":4003.23,"90th_percentile":4003.23,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":911.0,"10th_percentile":911.0,"90th_percentile":911.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":170102.69,"maximum":481347.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":353813.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":173504.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":270702.99},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":382731.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":409502.59},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":309304.69},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":309304.69},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":409502.59},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":170102.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":351792.19},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":481347.02},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":173504.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":171803.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":171803.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":398611.7},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":170102.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":416334.75},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":299889.12},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":416334.75},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":171803.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":178607.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":176906.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":171803.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":57534.66,"maximum":161708.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":119672.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58685.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":90942.66},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":129452.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":137572.39},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":103910.9},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":103910.9},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":137572.39},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57534.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":118184.58},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":161708.52},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58685.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58110.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58110.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":133913.59},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":57534.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":139867.65},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":100747.74},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":139867.65},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58110.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60411.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59836.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58110.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":26157.6,"maximum":72612.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":54407.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26680.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":40836.52},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":58854.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":61774.94},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":46659.73},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":46659.73},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":61774.94},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26157.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":53069.12},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":72612.94},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26680.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26419.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26419.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":60132.01},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":26157.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":62805.6},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45239.36},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":62805.6},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26419.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27465.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27203.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26419.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":31504.22,"maximum":87794.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":65528.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32134.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":49374.56},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":70884.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":74690.76},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":56415.28},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":56415.28},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":74690.76},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31504.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":64164.73},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":87794.74},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32134.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31819.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31819.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":72704.32},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":31504.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":75936.9},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":54697.93},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":75936.9},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31819.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33079.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32764.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31819.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":18136.88,"maximum":49837.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37724.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18499.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":28028.2},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40807.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":42399.31},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32024.96},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":32024.96},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":42399.31},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18136.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":36424.06},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":49837.98},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18499.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18318.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18318.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":41271.68},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":18136.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":43106.7},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31050.09},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":43106.7},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18318.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19043.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18862.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18318.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":16941.15,"maximum":46442.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35237.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17279.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":26118.74},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38117.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":39510.8},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29843.22},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":29843.22},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":39510.8},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16941.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":33942.62},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":46442.7},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17279.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17110.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17110.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":38459.99},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":16941.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":40170.0},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28934.76},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":40170.0},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17110.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17788.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17618.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17110.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34193.94,"10th_percentile":34193.94,"90th_percentile":34193.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":29394.63,"maximum":81804.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":61140.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29982.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":46005.75},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":66137.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":69594.63},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52566.08},{"payer_name":"Blue Cross","plan_name":"Health Options - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":19139.67,"maximum":52685.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39810.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19522.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":29629.56},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43064.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":44821.74},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33854.67},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":33854.67},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":44821.74},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19139.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":38505.1},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":52685.41},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19522.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19331.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19331.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27953.36,"10th_percentile":27953.36,"90th_percentile":27953.36,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19069.73,"10th_percentile":19069.73,"90th_percentile":19069.73,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":17960.05,"10th_percentile":17960.05,"90th_percentile":17960.05,"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":"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":16684.7,"maximum":45714.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34704.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17018.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":25709.21},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37540.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":38891.29},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29375.29},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":29375.29},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":38891.29},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16684.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":33410.41},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":45714.5},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17018.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16851.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16851.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":37856.96},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":16684.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":39540.15},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28481.07},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":39540.15},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16851.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17518.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17352.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16851.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":12880.77,"maximum":34913.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26792.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13138.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19634.7},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28981.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":29702.15},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22434.57},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":22434.57},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":29702.15},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12880.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":25516.28},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":34913.19},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13138.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13009.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13009.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - 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PPO","methodology":"fee schedule","standard_charge_dollar":21995.62},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16613.69},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":16613.69},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":21995.62},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9690.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":18895.82},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":25854.61},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9884.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9787.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9787.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21410.64},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":9690.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22362.6},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16107.95},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":22362.6},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9787.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10175.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10078.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9787.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":10663.99,"maximum":28618.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22181.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10877.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16094.72},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23993.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":24347.09},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18389.8},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":18389.8},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":24347.09},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10663.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":20915.9},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":28618.62},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10877.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10770.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10770.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23699.57},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":10663.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":24753.3},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17829.99},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":24753.3},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10770.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11197.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11090.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10770.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":954.0,"10th_percentile":483.98,"90th_percentile":9631.31,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":25609.84,"10th_percentile":25609.84,"90th_percentile":25609.84,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":5526.02,"10th_percentile":5526.02,"90th_percentile":5526.02,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":50313.86,"10th_percentile":50313.86,"90th_percentile":50313.86},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"1 through 10","median_amount":13138.27,"10th_percentile":13138.27,"90th_percentile":13138.27},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":595.54,"10th_percentile":483.98,"90th_percentile":14530.19,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23392.12,"10th_percentile":23392.12,"90th_percentile":23392.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1492.91,"10th_percentile":1492.91,"90th_percentile":7861.52,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":9630.58,"10th_percentile":9630.58,"90th_percentile":9630.58,"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."}]}]},{"description":"Signs And Symptoms Without Mcc","code_information":[{"code":"948","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6941.05,"maximum":18047.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14437.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7079.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10149.54},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15617.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":15353.59},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11596.84},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":11596.84},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":15353.59},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6941.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":13189.84},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":18047.27},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7079.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7010.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7010.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14945.25},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":6941.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15609.75},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11243.82},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":15609.75},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7010.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7288.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7218.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7010.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":322.48,"10th_percentile":298.96,"90th_percentile":9665.83,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"1 through 10","median_amount":8442.84,"10th_percentile":8442.84,"90th_percentile":8442.84},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":27000.32,"10th_percentile":27000.32,"90th_percentile":27000.32},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":11450.41,"10th_percentile":11450.41,"90th_percentile":11450.41,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14490.89,"10th_percentile":14490.89,"90th_percentile":14490.89,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8015.6,"10th_percentile":8015.6,"90th_percentile":10951.39,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":298.96,"10th_percentile":298.96,"90th_percentile":298.96,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12455.38,"10th_percentile":11855.38,"90th_percentile":86928.0,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":39821.15,"10th_percentile":39821.15,"90th_percentile":39821.15},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"23","median_amount":419.23,"10th_percentile":298.96,"90th_percentile":6135.11,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":13989.09,"10th_percentile":13989.09,"90th_percentile":13989.09},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":3849.04,"10th_percentile":3849.04,"90th_percentile":3849.04,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14449.57,"10th_percentile":14449.57,"90th_percentile":14449.57,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":321.28,"10th_percentile":298.96,"90th_percentile":6130.99,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":6102.99,"10th_percentile":298.96,"90th_percentile":6116.99,"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."}]}]},{"description":"Aftercare With Cc/Mcc","code_information":[{"code":"949","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10031.2,"maximum":26821.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20864.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10231.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15084.21},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22570.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":22818.45},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17235.18},{"payer_name":"Blue Cross","plan_name":"Health Options - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":5569.06,"maximum":14151.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11583.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5680.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":7958.61},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12530.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":197.86,"10th_percentile":156.15,"90th_percentile":426.65,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1895.0,"10th_percentile":1895.0,"90th_percentile":1895.0,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":76.88,"10th_percentile":74.34,"90th_percentile":324.53,"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":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1595.0,"10th_percentile":1595.0,"90th_percentile":1595.0,"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":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":74.04,"10th_percentile":74.04,"90th_percentile":74.04,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"27","median_amount":75.52,"10th_percentile":74.79,"90th_percentile":100.55,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":2008.07,"10th_percentile":2008.07,"90th_percentile":2008.07,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1970.0,"10th_percentile":1970.0,"90th_percentile":1970.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"29","median_amount":76.31,"10th_percentile":31.5,"90th_percentile":101.58,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"1 through 10","median_amount":78.57,"10th_percentile":78.57,"90th_percentile":78.57,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"11","median_amount":74.79,"10th_percentile":74.79,"90th_percentile":99.55,"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."}]}]},{"description":"Craniotomy For Multiple Significant Trauma","code_information":[{"code":"955","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":54028.47,"maximum":151752.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":112379.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55109.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":85343.62},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":121564.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":30462.53,"maximum":84836.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":63362.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31071.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":47711.08},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":68540.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":72174.34},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":54514.58},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":54514.58},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":72174.34},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30462.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":62002.95},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":84836.84},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31071.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30767.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30767.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1970.76,"10th_percentile":1970.76,"90th_percentile":1970.76,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":27813.76,"10th_percentile":27813.76,"90th_percentile":27813.76,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":71425.99,"10th_percentile":71425.99,"90th_percentile":71425.99,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":27862.56,"10th_percentile":27862.56,"90th_percentile":27862.56,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":61085.31,"maximum":171790.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":127057.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62307.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":96612.71},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":137441.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":146149.68},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":110389.49},{"payer_name":"Blue Cross","plan_name":"Health Options - 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Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":142262.77},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":61085.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":148588.05},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":107029.12},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":148588.05},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61696.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64139.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63528.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61696.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":34042.56,"maximum":95002.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":70808.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34723.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":53428.04},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":76595.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":80822.6},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":61046.77},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":61046.77},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":80822.6},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34042.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":69432.43},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":95002.38},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34723.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34382.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34382.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":23960.68,"maximum":66374.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":49838.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24439.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":37328.24},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":53911.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":56467.84},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42651.18},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":42651.18},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":56467.84},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23960.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":48509.94},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":66374.73},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24439.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24200.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24200.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":54966.05},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":23960.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":57409.95},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41352.83},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":57409.95},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24200.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25158.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24919.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24200.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":22290.95,"maximum":61633.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":46365.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22736.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":34661.85},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":50154.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":52434.28},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39604.56},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":39604.56},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":52434.28},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22290.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":45044.82},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":61633.52},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22736.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22513.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22513.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":51039.77},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":22290.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":53309.1},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38398.95},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":53309.1},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22513.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23405.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23182.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22513.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":47540.2,"10th_percentile":47540.2,"90th_percentile":47540.2,"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":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":19716.92,"10th_percentile":19716.92,"90th_percentile":19716.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Other Multiple Significant Trauma With Cc","code_information":[{"code":"964","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12753.73,"maximum":34552.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26527.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13008.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19431.84},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28695.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":29395.27},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22202.78},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":22202.78},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":29395.27},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12753.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":25252.65},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":34552.47},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13008.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12881.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12881.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":28613.49},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":12753.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29885.7},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21526.9},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":29885.7},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12881.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13391.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13263.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12881.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15462.93,"10th_percentile":15462.93,"90th_percentile":15462.93,"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":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":11199.87,"10th_percentile":11199.87,"90th_percentile":11199.87,"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."}]}]},{"description":"Other Multiple Significant Trauma Without Cc/Mcc","code_information":[{"code":"965","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8052.61,"maximum":21203.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16749.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8213.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11924.6},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18118.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":18038.79},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13625.02},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":13625.02},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":18038.79},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8052.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":15496.62},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":21203.57},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8213.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8133.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8133.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17559.04},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":8052.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18339.75},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13210.26},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":18339.75},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8133.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8455.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8374.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8133.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":369.04,"10th_percentile":369.04,"90th_percentile":369.04,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":49186.81,"maximum":138004.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":102308.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50170.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":77611.96},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":110670.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":117406.53},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":88679.27},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":88679.27},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":117406.53},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49186.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":100860.66},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":138004.71},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50170.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49678.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49678.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":114284.06},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":49186.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":119365.35},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":85979.78},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":119365.35},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49678.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51646.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51154.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49678.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":21525.56,"maximum":59460.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44773.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21956.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":33439.59},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48432.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":50585.33},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38208.01},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":38208.01},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":50585.33},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21525.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":43456.44},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":59460.18},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21956.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21740.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21740.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":23499.38,"maximum":65064.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48878.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23969.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":36591.59},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52873.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":55353.48},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41809.48},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":41809.48},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":55353.48},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23499.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":47552.62},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":65064.87},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23969.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23734.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23734.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":53881.33},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":23499.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":56277.0},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40536.76},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":56277.0},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23734.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24674.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24439.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23734.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":127253.16,"10th_percentile":127253.16,"90th_percentile":127253.16,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":45314.66,"10th_percentile":45314.66,"90th_percentile":45314.66,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":41161.78,"10th_percentile":41161.78,"90th_percentile":41161.78,"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":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"1 through 10","median_amount":15288.82,"10th_percentile":15288.82,"90th_percentile":15288.82},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":5798.56,"10th_percentile":5798.56,"90th_percentile":5798.56,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":10867.25,"maximum":29195.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22603.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11084.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16419.31},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24451.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":24838.1},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18760.67},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":18760.67},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":24838.1},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10867.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":21337.72},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":29195.78},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11084.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10975.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10975.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":24177.52},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":10867.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25252.5},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18189.57},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":25252.5},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10975.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11410.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11301.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10975.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":25839.65,"10th_percentile":25839.65,"90th_percentile":25839.65,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16542.58,"10th_percentile":16542.58,"90th_percentile":16542.58,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22283.29,"10th_percentile":22283.29,"90th_percentile":22283.29,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"1 through 10","median_amount":25106.79,"10th_percentile":25106.79,"90th_percentile":25106.79},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":9025.23,"10th_percentile":9025.23,"90th_percentile":9025.23,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":7752.49,"maximum":20351.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16125.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7907.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11445.33},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17443.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":17313.79},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13077.41},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":13077.41},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":17313.79},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7752.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":14873.79},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":20351.37},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7907.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7830.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7830.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16853.32},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":7752.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17602.65},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12679.32},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":17602.65},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7830.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8140.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8062.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7830.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - 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PPO","methodology":"fee schedule","standard_charge_dollar":24889.89},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18799.78},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":18799.78},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":24889.89},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10888.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":21382.2},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":29256.65},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11106.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10997.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10997.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - 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PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":37836.96,"maximum":105776.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":78700.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38593.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":59487.33},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":85133.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":89988.72},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":67970.11},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":67970.11},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":89988.72},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37836.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":77306.79},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":105776.63},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38593.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38215.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38215.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":87595.44},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":37836.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":91490.1},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":65901.02},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":91490.1},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38215.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39728.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39350.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38215.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":34917.12,"10th_percentile":1788.82,"90th_percentile":40763.28,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":83973.24,"10th_percentile":83973.24,"90th_percentile":83973.24,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":83907.03,"10th_percentile":83907.03,"90th_percentile":83907.03,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":65527.76,"10th_percentile":65527.76,"90th_percentile":65527.76,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":32614.71,"10th_percentile":1788.82,"90th_percentile":34324.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":74526.89,"10th_percentile":74526.89,"90th_percentile":77379.19,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"1 through 10","median_amount":13296.35,"10th_percentile":13296.35,"90th_percentile":13296.35,"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":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":18777.96,"10th_percentile":1788.82,"90th_percentile":34845.23,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":89003.18,"10th_percentile":89003.18,"90th_percentile":89003.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"17","median_amount":1788.82,"10th_percentile":1325.86,"90th_percentile":34220.55,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":27899.72,"10th_percentile":1788.82,"90th_percentile":34550.23,"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."}]}]},{"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":20105.14,"maximum":55426.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41818.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20507.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":31171.32},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45236.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":47154.03},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35616.29},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":35616.29},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":47154.03},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20105.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":40508.7},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":55426.88},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20507.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20306.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20306.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":45899.95},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":20105.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":47940.75},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34532.09},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":47940.75},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20306.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21110.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20909.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20306.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":921.26,"10th_percentile":200.0,"90th_percentile":1287.56,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"1 through 10","median_amount":18619.18,"10th_percentile":18619.18,"90th_percentile":18619.18},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":46208.54,"10th_percentile":46208.54,"90th_percentile":47115.92,"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":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":47503.14,"10th_percentile":47503.14,"90th_percentile":47503.14,"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33083.46,"10th_percentile":33083.46,"90th_percentile":33083.46,"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":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_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":8643.08,"10th_percentile":8643.08,"90th_percentile":17442.15,"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":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"1 through 10","median_amount":60891.39,"10th_percentile":60891.39,"90th_percentile":60891.39},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1287.56,"10th_percentile":921.26,"90th_percentile":3896.38,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_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":9077.26,"10th_percentile":9077.26,"90th_percentile":9077.26,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":44527.23,"10th_percentile":44527.23,"90th_percentile":44527.23,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":1287.56,"10th_percentile":1287.56,"90th_percentile":18827.64,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":13353.83,"10th_percentile":13353.83,"90th_percentile":13353.83,"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."}]}]},{"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":14194.0,"maximum":38642.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29523.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14477.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":21731.81},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31936.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":32874.52},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24830.72},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":24830.72},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":32874.52},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14194.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":28241.58},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":38642.13},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14477.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14335.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14335.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":32000.21},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":14194.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":33423.0},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24074.84},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":33423.0},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14335.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14903.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14761.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14335.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":13449.75,"10th_percentile":13449.75,"90th_percentile":13449.75,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26152.37,"10th_percentile":26152.37,"90th_percentile":26152.37,"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":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":627.72,"10th_percentile":627.72,"90th_percentile":12358.61,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":12387.14,"10th_percentile":12387.14,"90th_percentile":12387.14,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":27805.89,"maximum":77293.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":57836.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28362.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":43468.68},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62563.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":65756.71},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":49667.23},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":49667.23},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":65756.71},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27805.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":56489.75},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":77293.28},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28362.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28083.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28083.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":64007.89},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":27805.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":66853.8},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48155.31},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":66853.8},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28083.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29196.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28918.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28083.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"1 through 10","median_amount":1446.48,"10th_percentile":1446.48,"90th_percentile":1446.48,"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":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"1 through 10","median_amount":54926.13,"10th_percentile":54926.13,"90th_percentile":54926.13},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_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":1416.41,"10th_percentile":1416.41,"90th_percentile":1416.41,"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":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":25766.62,"10th_percentile":25766.62,"90th_percentile":25766.62,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":12671.34,"10th_percentile":12671.34,"90th_percentile":12671.34,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"1 through 10","median_amount":24290.52,"10th_percentile":24290.52,"90th_percentile":24290.52,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":25271.59,"10th_percentile":25271.59,"90th_percentile":25271.59,"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."}]}]},{"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":13635.04,"maximum":37054.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28360.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13907.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":20839.2},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30678.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":31524.25},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23810.83},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":23810.83},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":31524.25},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13635.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":27081.6},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":37054.96},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13907.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13771.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13771.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":30685.85},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":13635.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":32050.2},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23086.01},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":32050.2},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13771.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14316.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14180.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13771.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":12880.79,"10th_percentile":12880.79,"90th_percentile":12880.79,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":693.91,"10th_percentile":645.7,"90th_percentile":12842.21,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":860.78,"10th_percentile":645.7,"90th_percentile":12721.31,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":12640.31,"10th_percentile":693.91,"90th_percentile":12745.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"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":10106.62,"maximum":27035.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21021.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10308.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15204.66},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22739.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"fee schedule","standard_charge_dollar":23000.66},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17372.81},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"fee schedule","standard_charge_dollar":17372.81},{"payer_name":"Blue Cross","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":23000.66},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10106.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"fee schedule","standard_charge_dollar":19759.22},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"fee schedule","standard_charge_dollar":27035.96},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10308.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10207.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10207.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22388.94},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"fee schedule","standard_charge_dollar":10106.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23384.4},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16843.96},{"payer_name":"United Healthcare","plan_name":"International","methodology":"fee schedule","standard_charge_dollar":23384.4},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10207.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10611.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10510.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10207.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":628.04,"10th_percentile":628.04,"90th_percentile":628.04,"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."}]}]},{"description":"Inj, bupivacaine liposome","code_information":[{"code":"0763","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"1 through 10","median_amount":85676.18,"10th_percentile":85676.18,"90th_percentile":85676.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"1 through 10","median_amount":567.78,"10th_percentile":567.78,"90th_percentile":567.78},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"1 through 10","median_amount":13814.7,"10th_percentile":13814.7,"90th_percentile":13814.7},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":15383.0,"10th_percentile":15383.0,"90th_percentile":15383.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":233.81,"10th_percentile":233.81,"90th_percentile":233.81,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ketorolac tromethamine inj","code_information":[{"code":"0764","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"1 through 10","median_amount":1843.38,"10th_percentile":1843.38,"90th_percentile":1843.38,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 100% of Medicare]","count":"1 through 10","median_amount":528.91,"10th_percentile":528.91,"90th_percentile":528.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":9862.0,"10th_percentile":9862.0,"90th_percentile":9862.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month 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 ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"1 through 10","median_amount":41719.27,"10th_percentile":41719.27,"90th_percentile":41719.27},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":32.32,"10th_percentile":9.13,"90th_percentile":111.62,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":0.7,"10th_percentile":0.7,"90th_percentile":0.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inj, methylpred sod succ 5mg","code_information":[{"code":"0801","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":32.32,"10th_percentile":32.32,"90th_percentile":32.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"New Technology - Level 39 ($15,001-$20,000)","code_information":[{"code":"1576","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month 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 ($): 100% of Medicare]","count":"1 through 10","median_amount":24123.04,"10th_percentile":24123.04,"90th_percentile":24123.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":21056.51,"10th_percentile":21056.51,"90th_percentile":21056.51,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":6884.77,"10th_percentile":6884.77,"90th_percentile":6884.77,"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."}]}]},{"description":"Gen, neuro, imp led, ex cntr","code_information":[{"code":"2039","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":40302.97,"10th_percentile":40302.97,"90th_percentile":40302.97,"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":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":41075.36,"10th_percentile":41075.36,"90th_percentile":41075.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Cath renal denerv ultrasnd","code_information":[{"code":"2052","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 100% of Medicare]","count":"1 through 10","median_amount":25921.13,"10th_percentile":25921.13,"90th_percentile":25921.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month 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 ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Brachytx, non-str,Yttrium-90","code_information":[{"code":"2616","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":28296.67,"10th_percentile":28296.67,"90th_percentile":28296.67,"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":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Clinic Visits and Related Services","code_information":[{"code":"5012","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"141","median_amount":213.48,"10th_percentile":160.22,"90th_percentile":472.2,"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":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":1318.35,"10th_percentile":1318.35,"90th_percentile":1318.35},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"22","median_amount":107.6,"10th_percentile":39.82,"90th_percentile":210.06,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"556","median_amount":127.37,"10th_percentile":120.26,"90th_percentile":344.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"271","median_amount":793.2,"10th_percentile":202.42,"90th_percentile":1827.0},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"76","median_amount":847.5,"10th_percentile":288.9,"90th_percentile":1217.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"154","median_amount":1449.66,"10th_percentile":380.85,"90th_percentile":2039.04},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"304","median_amount":291.06,"10th_percentile":60.04,"90th_percentile":531.23,"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":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"499","median_amount":458.0,"10th_percentile":263.5,"90th_percentile":1101.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"354","median_amount":917.0,"10th_percentile":280.0,"90th_percentile":971.0,"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":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"34","median_amount":462.0,"10th_percentile":280.0,"90th_percentile":917.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"1 through 10","median_amount":823.0,"10th_percentile":823.0,"90th_percentile":823.0,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"245","median_amount":127.29,"10th_percentile":119.74,"90th_percentile":345.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"242","median_amount":402.0,"10th_percentile":300.0,"90th_percentile":1101.0,"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":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"11","median_amount":971.0,"10th_percentile":387.0,"90th_percentile":1040.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"282","median_amount":996.85,"10th_percentile":234.2,"90th_percentile":2012.26},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"23","median_amount":980.27,"10th_percentile":563.19,"90th_percentile":1407.53},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"1 through 10","median_amount":555.38,"10th_percentile":555.38,"90th_percentile":555.38},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"87","median_amount":177.42,"10th_percentile":125.0,"90th_percentile":193.69,"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":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":129.36,"10th_percentile":126.77,"90th_percentile":231.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"254","median_amount":130.65,"10th_percentile":128.04,"90th_percentile":349.05,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":1419.35,"10th_percentile":1128.01,"90th_percentile":2825.0},{"payer_name":"Molina","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":"103","median_amount":157.56,"10th_percentile":75.78,"90th_percentile":160.22,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":359.0,"10th_percentile":359.0,"90th_percentile":359.0},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"219","median_amount":160.22,"10th_percentile":40.12,"90th_percentile":176.08,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"918","median_amount":160.22,"10th_percentile":67.34,"90th_percentile":173.4,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":161.29,"10th_percentile":161.29,"90th_percentile":161.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"408","median_amount":359.0,"10th_percentile":144.0,"90th_percentile":1237.11,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"40","median_amount":544.8,"10th_percentile":150.9,"90th_percentile":783.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":359.0,"10th_percentile":310.0,"90th_percentile":359.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"401","median_amount":129.14,"10th_percentile":122.91,"90th_percentile":349.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"1 through 10","median_amount":135.82,"10th_percentile":28.39,"90th_percentile":233.27,"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] [APC ($): 104% of Medicare]","count":"1 through 10","median_amount":131.84,"10th_percentile":124.53,"90th_percentile":358.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"134","median_amount":130.65,"10th_percentile":120.45,"90th_percentile":384.13,"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."}]}]},{"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"1 through 10","median_amount":176.76,"10th_percentile":176.76,"90th_percentile":176.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"1 through 10","median_amount":156.68,"10th_percentile":156.68,"90th_percentile":156.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":150.25,"10th_percentile":150.25,"90th_percentile":150.25,"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":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"1 through 10","median_amount":173.4,"10th_percentile":163.46,"90th_percentile":442.8},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":419.28,"10th_percentile":419.28,"90th_percentile":419.28},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"1 through 10","median_amount":198.86,"10th_percentile":198.86,"90th_percentile":198.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"1 through 10","median_amount":540.0,"10th_percentile":540.0,"90th_percentile":540.0,"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":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":475.0,"10th_percentile":475.0,"90th_percentile":738.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":86.97,"10th_percentile":86.97,"90th_percentile":86.97,"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":"Blue Cross","plan_name":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"1 through 10","median_amount":332.0,"10th_percentile":332.0,"90th_percentile":332.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"1 through 10","median_amount":475.0,"10th_percentile":475.0,"90th_percentile":475.0,"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":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"1 through 10","median_amount":497.41,"10th_percentile":497.41,"90th_percentile":497.41},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"1 through 10","median_amount":77.44,"10th_percentile":77.44,"90th_percentile":77.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":89.26,"10th_percentile":89.26,"90th_percentile":89.26,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","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":197.66,"10th_percentile":197.66,"90th_percentile":247.5,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":109.94,"10th_percentile":109.94,"90th_percentile":109.94,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"14","median_amount":126.32,"10th_percentile":91.87,"90th_percentile":197.66,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":738.0,"10th_percentile":738.0,"90th_percentile":1942.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":88.78,"10th_percentile":88.78,"90th_percentile":89.26,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":89.26,"10th_percentile":89.26,"90th_percentile":89.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 2 Type A ED Visits","code_information":[{"code":"5022","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"23","median_amount":317.92,"10th_percentile":301.12,"90th_percentile":317.92,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"38","median_amount":125.62,"10th_percentile":77.1,"90th_percentile":169.49,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"88","median_amount":158.28,"10th_percentile":149.75,"90th_percentile":158.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"47","median_amount":726.6,"10th_percentile":301.12,"90th_percentile":1084.8},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"17","median_amount":491.1,"10th_percentile":363.3,"90th_percentile":1176.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"37","median_amount":816.21,"10th_percentile":615.6,"90th_percentile":1237.99},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"138","median_amount":357.66,"10th_percentile":357.66,"90th_percentile":357.66,"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":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"83","median_amount":830.0,"10th_percentile":353.0,"90th_percentile":1402.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"105","median_amount":752.0,"10th_percentile":752.0,"90th_percentile":796.0,"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":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"11","median_amount":752.0,"10th_percentile":752.0,"90th_percentile":853.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"1 through 10","median_amount":830.0,"10th_percentile":830.0,"90th_percentile":830.0,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"48","median_amount":156.42,"10th_percentile":148.15,"90th_percentile":156.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"58","median_amount":853.0,"10th_percentile":353.0,"90th_percentile":1637.0,"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":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"1 through 10","median_amount":1211.0,"10th_percentile":1211.0,"90th_percentile":1211.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"88","median_amount":816.21,"10th_percentile":420.22,"90th_percentile":1236.79},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"1 through 10","median_amount":443.57,"10th_percentile":434.45,"90th_percentile":568.04},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"48","median_amount":121.83,"10th_percentile":77.17,"90th_percentile":172.16,"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":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":158.18,"10th_percentile":149.95,"90th_percentile":158.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"70","median_amount":159.84,"10th_percentile":88.35,"90th_percentile":161.7,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":919.09,"10th_percentile":792.94,"90th_percentile":1211.0},{"payer_name":"Molina","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":"139","median_amount":115.09,"10th_percentile":83.11,"90th_percentile":181.16,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"246","median_amount":121.96,"10th_percentile":70.4,"90th_percentile":189.53,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"618","median_amount":120.08,"10th_percentile":70.4,"90th_percentile":189.53,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"118","median_amount":1211.0,"10th_percentile":371.78,"90th_percentile":2247.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"15","median_amount":339.08,"10th_percentile":195.6,"90th_percentile":856.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":1211.0,"10th_percentile":1211.0,"90th_percentile":1211.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"108","median_amount":159.34,"10th_percentile":151.43,"90th_percentile":160.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"1 through 10","median_amount":166.9,"10th_percentile":166.9,"90th_percentile":166.9,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"1 through 10","median_amount":164.21,"10th_percentile":162.01,"90th_percentile":164.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"19","median_amount":159.84,"10th_percentile":157.34,"90th_percentile":160.14,"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 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":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"301","median_amount":555.88,"10th_percentile":525.3,"90th_percentile":841.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":3321.8,"10th_percentile":3321.8,"90th_percentile":3321.8},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"347","median_amount":119.94,"10th_percentile":102.35,"90th_percentile":238.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"377","median_amount":274.88,"10th_percentile":259.8,"90th_percentile":372.64,"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":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"325","median_amount":1267.8,"10th_percentile":525.3,"90th_percentile":2136.6},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"88","median_amount":1037.4,"10th_percentile":690.6,"90th_percentile":1916.18,"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":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"210","median_amount":1569.3,"10th_percentile":1146.28,"90th_percentile":2373.61},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"1 through 10","median_amount":4175.0,"10th_percentile":4175.0,"90th_percentile":4175.0},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"982","median_amount":625.37,"10th_percentile":625.37,"90th_percentile":946.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"396","median_amount":830.0,"10th_percentile":353.0,"90th_percentile":1701.0,"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":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"657","median_amount":752.0,"10th_percentile":752.0,"90th_percentile":1494.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. 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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":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"1 through 10","median_amount":830.0,"10th_percentile":830.0,"90th_percentile":830.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"159","median_amount":273.49,"10th_percentile":258.45,"90th_percentile":351.76,"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":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"350","median_amount":853.0,"10th_percentile":353.0,"90th_percentile":1600.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"13","median_amount":748.46,"10th_percentile":664.01,"90th_percentile":1494.0,"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":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"497","median_amount":1745.77,"10th_percentile":1225.96,"90th_percentile":2689.25},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"38","median_amount":1016.89,"10th_percentile":759.24,"90th_percentile":1774.44},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"300","median_amount":153.89,"10th_percentile":83.36,"90th_percentile":2303.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"13","median_amount":274.78,"10th_percentile":272.38,"90th_percentile":418.41,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"376","median_amount":275.11,"10th_percentile":89.26,"90th_percentile":333.25,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"28","median_amount":1666.39,"10th_percentile":1309.91,"90th_percentile":2263.0},{"payer_name":"Molina","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":"1068","median_amount":115.09,"10th_percentile":101.68,"90th_percentile":304.01,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":3626.95,"10th_percentile":3626.95,"90th_percentile":3626.95},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1819","median_amount":127.24,"10th_percentile":88.96,"90th_percentile":312.28,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"4353","median_amount":126.99,"10th_percentile":91.91,"90th_percentile":314.22,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"623","median_amount":2597.0,"10th_percentile":647.36,"90th_percentile":2800.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"91","median_amount":712.32,"10th_percentile":317.26,"90th_percentile":1275.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"12","median_amount":2597.0,"10th_percentile":2313.0,"90th_percentile":2597.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"598","median_amount":277.81,"10th_percentile":262.65,"90th_percentile":414.97,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"1 through 10","median_amount":291.83,"10th_percentile":291.83,"90th_percentile":428.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"20","median_amount":285.78,"10th_percentile":164.81,"90th_percentile":431.45,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"199","median_amount":277.61,"10th_percentile":262.37,"90th_percentile":277.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 4 Type A ED Visits","code_information":[{"code":"5024","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"457","median_amount":1277.84,"10th_percentile":685.23,"90th_percentile":1856.42,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":6030.75,"10th_percentile":5669.4,"90th_percentile":12027.0},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"266","median_amount":230.7,"10th_percentile":118.54,"90th_percentile":479.22,"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 ($): 100% of Medicare]","count":"936","median_amount":636.61,"10th_percentile":275.18,"90th_percentile":893.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"615","median_amount":2199.6,"10th_percentile":500.0,"90th_percentile":6736.6},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"183","median_amount":2135.34,"10th_percentile":1374.55,"90th_percentile":3809.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"342","median_amount":3487.63,"10th_percentile":1971.9,"90th_percentile":6914.18},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"1493","median_amount":1206.55,"10th_percentile":804.34,"90th_percentile":2078.45,"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":"Blue Cross","plan_name":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"856","median_amount":2346.61,"10th_percentile":805.74,"90th_percentile":2738.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1355","median_amount":2119.0,"10th_percentile":2119.0,"90th_percentile":2244.0,"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":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"1 through 10","median_amount":2738.0,"10th_percentile":2738.0,"90th_percentile":5733.0,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"440","median_amount":630.65,"10th_percentile":420.59,"90th_percentile":908.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"806","median_amount":2402.0,"10th_percentile":1422.0,"90th_percentile":2543.0,"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":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"23","median_amount":2119.0,"10th_percentile":590.39,"90th_percentile":2738.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"704","median_amount":3506.7,"10th_percentile":1544.8,"90th_percentile":8463.4},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"81","median_amount":2164.25,"10th_percentile":981.31,"90th_percentile":4312.58},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"212","median_amount":352.82,"10th_percentile":76.48,"90th_percentile":2391.48,"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":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"27","median_amount":642.17,"10th_percentile":421.28,"90th_percentile":911.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"899","median_amount":596.3,"10th_percentile":277.61,"90th_percentile":903.83,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"51","median_amount":3995.06,"10th_percentile":2557.31,"90th_percentile":7623.97},{"payer_name":"Molina","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":"560","median_amount":197.66,"10th_percentile":115.09,"90th_percentile":392.86,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":8421.8,"10th_percentile":8421.8,"90th_percentile":8421.8},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"999","median_amount":288.8,"10th_percentile":115.09,"90th_percentile":471.02,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"2793","median_amount":266.22,"10th_percentile":110.29,"90th_percentile":415.13,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":386.58,"10th_percentile":386.58,"90th_percentile":416.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1020","median_amount":2597.0,"10th_percentile":1359.4,"90th_percentile":2800.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"136","median_amount":1791.16,"10th_percentile":612.82,"90th_percentile":3559.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"28","median_amount":2597.0,"10th_percentile":2597.0,"90th_percentile":5607.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1232","median_amount":631.9,"10th_percentile":280.72,"90th_percentile":920.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"1 through 10","median_amount":560.87,"10th_percentile":428.1,"90th_percentile":3698.91,"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 ($): 104% of Medicare]","count":"40","median_amount":521.4,"10th_percentile":286.08,"90th_percentile":857.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"343","median_amount":635.21,"10th_percentile":423.07,"90th_percentile":917.13,"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."}]}]},{"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"558","median_amount":2435.8,"10th_percentile":1389.92,"90th_percentile":5342.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":14563.05,"10th_percentile":9175.75,"90th_percentile":15709.7},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"77","median_amount":373.24,"10th_percentile":123.68,"90th_percentile":743.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1541","median_amount":1268.79,"10th_percentile":683.56,"90th_percentile":2709.55,"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":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"604","median_amount":2556.02,"10th_percentile":300.0,"90th_percentile":10603.2},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"216","median_amount":4929.3,"10th_percentile":1929.0,"90th_percentile":8411.7,"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":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"438","median_amount":8694.66,"10th_percentile":3098.73,"90th_percentile":15725.13},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"1355","median_amount":2201.27,"10th_percentile":1431.95,"90th_percentile":6010.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"1079","median_amount":2402.0,"10th_percentile":1161.6,"90th_percentile":9091.0,"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":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. 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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":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"570","median_amount":1241.45,"10th_percentile":683.84,"90th_percentile":2681.74,"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":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"1005","median_amount":2402.0,"10th_percentile":1902.0,"90th_percentile":7262.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"31","median_amount":2543.0,"10th_percentile":2119.0,"90th_percentile":9791.0,"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":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"678","median_amount":7774.97,"10th_percentile":2411.66,"90th_percentile":15768.94},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"130","median_amount":5508.99,"10th_percentile":2182.99,"90th_percentile":10261.2},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"74","median_amount":582.85,"10th_percentile":153.89,"90th_percentile":2546.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"36","median_amount":1072.72,"10th_percentile":683.46,"90th_percentile":2620.04,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1374","median_amount":994.95,"10th_percentile":360.14,"90th_percentile":2687.68,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"51","median_amount":9489.45,"10th_percentile":3448.43,"90th_percentile":19900.46},{"payer_name":"Molina","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":"202","median_amount":349.02,"10th_percentile":125.35,"90th_percentile":627.88,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":5900.0,"10th_percentile":5900.0,"90th_percentile":22944.65},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"320","median_amount":392.06,"10th_percentile":141.92,"90th_percentile":804.45,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1084","median_amount":342.51,"10th_percentile":133.77,"90th_percentile":608.57,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":382.78,"10th_percentile":382.78,"90th_percentile":382.78,"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":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1080","median_amount":2597.0,"10th_percentile":1532.16,"90th_percentile":9350.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"207","median_amount":4873.12,"10th_percentile":1200.67,"90th_percentile":9262.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"23","median_amount":2597.0,"10th_percentile":2597.0,"90th_percentile":16835.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1770","median_amount":1257.6,"10th_percentile":683.87,"90th_percentile":2750.22,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"12","median_amount":1022.59,"10th_percentile":837.59,"90th_percentile":2645.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"65","median_amount":1066.55,"10th_percentile":524.11,"90th_percentile":2725.5,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"691","median_amount":1283.98,"10th_percentile":690.37,"90th_percentile":2733.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Critical Care","code_information":[{"code":"5041","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"30","median_amount":5315.48,"10th_percentile":2749.82,"90th_percentile":5721.84,"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":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":1557.43,"10th_percentile":1557.43,"90th_percentile":1557.43},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"1 through 10","median_amount":130.04,"10th_percentile":130.04,"90th_percentile":130.04,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"88","median_amount":2605.09,"10th_percentile":1084.02,"90th_percentile":2879.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"24","median_amount":3191.4,"10th_percentile":345.0,"90th_percentile":10233.0},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":12466.19,"10th_percentile":12466.19,"90th_percentile":12671.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"13","median_amount":7353.88,"10th_percentile":3674.11,"90th_percentile":16948.34},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"44","median_amount":5979.92,"10th_percentile":2378.9,"90th_percentile":6400.15,"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":"Blue Cross","plan_name":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"42","median_amount":7262.0,"10th_percentile":2030.51,"90th_percentile":10073.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"41","median_amount":2119.0,"10th_percentile":1696.0,"90th_percentile":6403.0,"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":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":2119.0,"10th_percentile":2119.0,"90th_percentile":6403.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"1 through 10","median_amount":9791.0,"10th_percentile":9791.0,"90th_percentile":9791.0,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"40","median_amount":2615.22,"10th_percentile":1040.38,"90th_percentile":2818.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"33","median_amount":3508.0,"10th_percentile":1902.0,"90th_percentile":7689.0,"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":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"1 through 10","median_amount":5970.11,"10th_percentile":5970.11,"90th_percentile":5970.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"30","median_amount":9613.15,"10th_percentile":4958.65,"90th_percentile":27757.25},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"1 through 10","median_amount":7517.71,"10th_percentile":5450.37,"90th_percentile":13858.18},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"1 through 10","median_amount":1191.1,"10th_percentile":1191.1,"90th_percentile":1191.1,"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":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":2621.61,"10th_percentile":2621.61,"90th_percentile":2621.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"97","median_amount":2419.85,"10th_percentile":838.47,"90th_percentile":2747.28,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":23938.1,"10th_percentile":11438.03,"90th_percentile":35964.87},{"payer_name":"Molina","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":592.97,"10th_percentile":414.68,"90th_percentile":793.2,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"12","median_amount":463.47,"10th_percentile":206.39,"90th_percentile":1481.14,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"35","median_amount":382.88,"10th_percentile":170.59,"90th_percentile":779.05,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"37","median_amount":2800.0,"10th_percentile":840.03,"90th_percentile":14262.67,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"1 through 10","median_amount":8712.72,"10th_percentile":4356.36,"90th_percentile":9904.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":14874.13,"10th_percentile":14874.13,"90th_percentile":14874.13,"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":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"106","median_amount":2633.14,"10th_percentile":854.26,"90th_percentile":2890.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"1 through 10","median_amount":857.71,"10th_percentile":857.71,"90th_percentile":857.71,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"1 through 10","median_amount":2711.27,"10th_percentile":2711.27,"90th_percentile":2711.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"42","median_amount":2501.07,"10th_percentile":1319.79,"90th_percentile":2750.73,"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."}]}]},{"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"1 through 10","median_amount":257.0,"10th_percentile":257.0,"90th_percentile":257.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"13","median_amount":322.23,"10th_percentile":196.26,"90th_percentile":392.52,"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":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"11","median_amount":571.8,"10th_percentile":368.6,"90th_percentile":1527.0},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. 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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":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":280.0,"10th_percentile":280.0,"90th_percentile":1696.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":280.0,"10th_percentile":280.0,"90th_percentile":1914.0,"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":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":301.09,"10th_percentile":181.35,"90th_percentile":1876.0,"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":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"13","median_amount":562.0,"10th_percentile":315.0,"90th_percentile":1029.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"11","median_amount":791.95,"10th_percentile":50.0,"90th_percentile":1554.92},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":201.44,"10th_percentile":197.71,"90th_percentile":331.16,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":1048.79,"10th_percentile":1048.79,"90th_percentile":1048.79},{"payer_name":"Molina","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":112.01,"10th_percentile":112.01,"90th_percentile":121.96,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":122.0,"10th_percentile":121.96,"90th_percentile":251.4,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"11","median_amount":359.0,"10th_percentile":262.25,"90th_percentile":359.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"12","median_amount":201.44,"10th_percentile":197.92,"90th_percentile":325.96,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":329.36,"10th_percentile":201.44,"90th_percentile":487.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 2 Skin Procedures","code_information":[{"code":"5052","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"22","median_amount":1604.16,"10th_percentile":802.08,"90th_percentile":3123.24,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"1 through 10","median_amount":361.29,"10th_percentile":361.29,"90th_percentile":362.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"42","median_amount":2121.6,"10th_percentile":802.08,"90th_percentile":3208.32},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":1718.1,"10th_percentile":1718.1,"90th_percentile":1905.6,"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":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"42","median_amount":2510.0,"10th_percentile":1143.14,"90th_percentile":4797.63},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"17","median_amount":1193.4,"10th_percentile":628.72,"90th_percentile":3609.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. 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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":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. 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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":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"110","median_amount":1588.0,"10th_percentile":1388.0,"90th_percentile":2402.0,"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":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"1 through 10","median_amount":1681.0,"10th_percentile":1681.0,"90th_percentile":1681.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"59","median_amount":2140.82,"10th_percentile":1120.12,"90th_percentile":4644.54},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"1 through 10","median_amount":1516.18,"10th_percentile":1516.18,"90th_percentile":1516.18},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"1 through 10","median_amount":2644.77,"10th_percentile":2644.77,"90th_percentile":3210.93,"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":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":1560.63,"10th_percentile":1182.96,"90th_percentile":2193.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"217","median_amount":926.35,"10th_percentile":486.83,"90th_percentile":1702.3,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","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":"16","median_amount":251.4,"10th_percentile":251.4,"90th_percentile":347.35,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"17","median_amount":449.14,"10th_percentile":361.34,"90th_percentile":983.41,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"59","median_amount":254.05,"10th_percentile":251.4,"90th_percentile":370.5,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"59","median_amount":929.7,"10th_percentile":359.0,"90th_percentile":2597.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"1 through 10","median_amount":2551.48,"10th_percentile":2551.48,"90th_percentile":2551.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"294","median_amount":741.46,"10th_percentile":405.05,"90th_percentile":1482.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 104% of Medicare]","count":"1 through 10","median_amount":883.25,"10th_percentile":573.78,"90th_percentile":1807.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"155","median_amount":852.69,"10th_percentile":483.77,"90th_percentile":1722.85,"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 Skin Procedures","code_information":[{"code":"5053","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"1 through 10","median_amount":1784.76,"10th_percentile":1784.76,"90th_percentile":1784.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"27","median_amount":1204.3,"10th_percentile":606.15,"90th_percentile":2585.28,"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":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"1 through 10","median_amount":2145.22,"10th_percentile":488.33,"90th_percentile":3608.68},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":3961.6,"10th_percentile":3961.6,"90th_percentile":3961.6},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"1 through 10","median_amount":625.37,"10th_percentile":625.37,"90th_percentile":625.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"12","median_amount":2190.41,"10th_percentile":1764.0,"90th_percentile":2727.0,"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":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":1764.0,"10th_percentile":1764.0,"90th_percentile":2119.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":1764.0,"10th_percentile":1764.0,"90th_percentile":1764.0,"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":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"11","median_amount":2067.89,"10th_percentile":604.61,"90th_percentile":2520.37,"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":"Blue Cross","plan_name":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"1 through 10","median_amount":2402.0,"10th_percentile":1200.06,"90th_percentile":2402.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"1 through 10","median_amount":2377.88,"10th_percentile":2170.49,"90th_percentile":3107.45},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"22","median_amount":1479.24,"10th_percentile":608.17,"90th_percentile":2565.73,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","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":251.4,"10th_percentile":251.4,"90th_percentile":251.4,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":386.89,"10th_percentile":386.89,"90th_percentile":386.89,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":251.4,"10th_percentile":251.4,"90th_percentile":656.23,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":1282.5,"10th_percentile":1282.5,"90th_percentile":2135.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"35","median_amount":1358.38,"10th_percentile":693.22,"90th_percentile":2653.41,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"17","median_amount":1903.04,"10th_percentile":824.51,"90th_percentile":3646.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 4 Skin Procedures","code_information":[{"code":"5054","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"1 through 10","median_amount":32597.0,"10th_percentile":32597.0,"90th_percentile":32597.0,"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":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 100% of Medicare]","count":"13","median_amount":1799.42,"10th_percentile":484.48,"90th_percentile":3268.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":8011.9,"10th_percentile":8011.9,"90th_percentile":8011.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":1907.95,"10th_percentile":1681.89,"90th_percentile":19852.05},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"1 through 10","median_amount":4131.32,"10th_percentile":4131.32,"90th_percentile":4131.32,"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":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"1 through 10","median_amount":5161.0,"10th_percentile":2616.8,"90th_percentile":13692.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"13","median_amount":296.01,"10th_percentile":0.01,"90th_percentile":18505.2,"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":"Blue Cross","plan_name":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month 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 ($): 100% of Medicare]","count":"1 through 10","median_amount":2491.21,"10th_percentile":2201.38,"90th_percentile":3016.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"1 through 10","median_amount":2805.87,"10th_percentile":2759.35,"90th_percentile":5141.93},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":2637.16,"10th_percentile":933.6,"90th_percentile":3989.0,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":28010.31,"10th_percentile":28010.31,"90th_percentile":28010.31},{"payer_name":"Molina","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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"19","median_amount":1929.3,"10th_percentile":524.99,"90th_percentile":2763.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":2145.37,"10th_percentile":1820.91,"90th_percentile":2775.09,"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."}]}]},{"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":4695.62,"10th_percentile":4695.62,"90th_percentile":4695.62,"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":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"1 through 10","median_amount":19599.05,"10th_percentile":19599.05,"90th_percentile":19599.05},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"1 through 10","median_amount":10445.0,"10th_percentile":10445.0,"90th_percentile":10445.0,"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":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":4519.39,"10th_percentile":4519.39,"90th_percentile":4519.39,"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":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"1 through 10","median_amount":8911.0,"10th_percentile":8911.0,"90th_percentile":8911.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":4390.34,"10th_percentile":4390.34,"90th_percentile":4390.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":9132.5,"10th_percentile":8534.0,"90th_percentile":17580.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hyperbaric Oxygen","code_information":[{"code":"5061","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 100% of Medicare]","count":"1 through 10","median_amount":6773.74,"10th_percentile":3386.43,"90th_percentile":10868.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"50","median_amount":315.0,"10th_percentile":315.0,"90th_percentile":315.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"37","median_amount":353.0,"10th_percentile":353.0,"90th_percentile":2119.0,"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":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"29","median_amount":280.0,"10th_percentile":280.0,"90th_percentile":296.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month 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 ($): 100% of Medicare]","count":"1 through 10","median_amount":6537.84,"10th_percentile":6537.84,"90th_percentile":10896.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"51","median_amount":402.0,"10th_percentile":315.0,"90th_percentile":402.0,"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":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"12","median_amount":6728.49,"10th_percentile":505.75,"90th_percentile":9103.5,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":43670.14,"10th_percentile":43670.14,"90th_percentile":43670.14},{"payer_name":"Molina","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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":9394.74,"10th_percentile":9394.74,"90th_percentile":9394.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"12","median_amount":6028.44,"10th_percentile":1448.3,"90th_percentile":11508.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"17","median_amount":4451.43,"10th_percentile":213.6,"90th_percentile":13517.78,"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."}]}]},{"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"1 through 10","median_amount":1412.5,"10th_percentile":1412.5,"90th_percentile":1412.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"1 through 10","median_amount":247.21,"10th_percentile":247.21,"90th_percentile":247.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"20","median_amount":697.62,"10th_percentile":640.23,"90th_percentile":697.92,"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":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"1 through 10","median_amount":1835.4,"10th_percentile":697.62,"90th_percentile":3670.8},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"12","median_amount":1412.5,"10th_percentile":971.7,"90th_percentile":1835.4,"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":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"14","median_amount":1725.03,"10th_percentile":1544.23,"90th_percentile":1827.67},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"1 through 10","median_amount":1589.06,"10th_percentile":1589.06,"90th_percentile":2550.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"21","median_amount":2550.51,"10th_percentile":987.73,"90th_percentile":3195.0,"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":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":2816.0,"10th_percentile":2816.0,"90th_percentile":2982.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":2816.0,"10th_percentile":2688.0,"90th_percentile":3195.0,"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":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":817.91,"10th_percentile":694.95,"90th_percentile":2859.0,"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":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"12","median_amount":3059.0,"10th_percentile":2775.0,"90th_percentile":3239.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"1 through 10","median_amount":2215.53,"10th_percentile":2061.77,"90th_percentile":3398.99},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"1 through 10","median_amount":1120.69,"10th_percentile":1120.69,"90th_percentile":2241.39},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"1 through 10","median_amount":262.55,"10th_percentile":262.55,"90th_percentile":262.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"25","median_amount":704.94,"10th_percentile":699.04,"90th_percentile":709.47,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":2831.44,"10th_percentile":2831.44,"90th_percentile":2831.44},{"payer_name":"Molina","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":905.13,"10th_percentile":905.13,"90th_percentile":905.13,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":403.94,"10th_percentile":240.01,"90th_percentile":563.23,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":268.07,"10th_percentile":240.01,"90th_percentile":854.26,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"12","median_amount":1986.0,"10th_percentile":1038.96,"90th_percentile":2135.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"1 through 10","median_amount":777.36,"10th_percentile":777.36,"90th_percentile":1177.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"28","median_amount":702.95,"10th_percentile":699.05,"90th_percentile":713.75,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"25","median_amount":706.04,"10th_percentile":702.94,"90th_percentile":830.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 2 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5072","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"12","median_amount":3252.72,"10th_percentile":2984.96,"90th_percentile":10127.76,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 100% of Medicare]","count":"45","median_amount":1598.71,"10th_percentile":1593.83,"90th_percentile":2568.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"1 through 10","median_amount":5464.2,"10th_percentile":3750.6,"90th_percentile":6523.2},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":3107.7,"10th_percentile":3107.7,"90th_percentile":7745.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"14","median_amount":4893.06,"10th_percentile":3946.97,"90th_percentile":10288.15},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"20","median_amount":3659.31,"10th_percentile":3659.31,"90th_percentile":3668.15,"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":"Blue Cross","plan_name":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"12","median_amount":4936.86,"10th_percentile":1867.45,"90th_percentile":5576.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"27","median_amount":4228.0,"10th_percentile":4228.0,"90th_percentile":11427.0,"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":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":4228.0,"10th_percentile":4228.0,"90th_percentile":4477.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month 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 ($): 100% of Medicare]","count":"20","median_amount":1600.34,"10th_percentile":1468.6,"90th_percentile":2826.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"26","median_amount":4793.0,"10th_percentile":3604.62,"90th_percentile":5075.0,"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":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"19","median_amount":4591.3,"10th_percentile":3126.02,"90th_percentile":12507.73},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"1 through 10","median_amount":3061.6,"10th_percentile":2970.33,"90th_percentile":3123.38},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"1 through 10","median_amount":11690.68,"10th_percentile":11690.68,"90th_percentile":11690.68,"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":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":1462.63,"10th_percentile":1462.63,"90th_percentile":1462.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"47","median_amount":1615.67,"10th_percentile":1485.14,"90th_percentile":1623.85,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":15862.23,"10th_percentile":15862.23,"90th_percentile":15862.23},{"payer_name":"Molina","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":430.77,"10th_percentile":430.77,"90th_percentile":430.77,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":1205.02,"10th_percentile":1205.02,"90th_percentile":6735.0,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":430.6,"10th_percentile":430.6,"90th_percentile":478.91,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"11","median_amount":2738.0,"10th_percentile":1986.0,"90th_percentile":4010.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"21","median_amount":4599.84,"10th_percentile":728.64,"90th_percentile":13720.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":4959.0,"10th_percentile":4959.0,"90th_percentile":4959.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"52","median_amount":1616.77,"10th_percentile":1609.77,"90th_percentile":1650.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"32","median_amount":1613.67,"10th_percentile":1481.15,"90th_percentile":2594.65,"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."}]}]},{"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"1 through 10","median_amount":6121.44,"10th_percentile":6121.44,"90th_percentile":6123.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"1 through 10","median_amount":1572.9,"10th_percentile":1572.9,"90th_percentile":1572.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"19","median_amount":2820.41,"10th_percentile":2568.42,"90th_percentile":2820.91,"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":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"1 through 10","median_amount":13416.3,"10th_percentile":13416.3,"90th_percentile":13416.3},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":8682.9,"10th_percentile":3905.1,"90th_percentile":12595.05,"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":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":11780.77,"10th_percentile":6068.72,"90th_percentile":21667.49},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"13","median_amount":6463.96,"10th_percentile":6463.96,"90th_percentile":6905.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"1 through 10","median_amount":8224.2,"10th_percentile":7779.71,"90th_percentile":9520.2,"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":"Blue Cross","plan_name":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":7044.0,"10th_percentile":5635.0,"90th_percentile":7458.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":5635.0,"10th_percentile":5635.0,"90th_percentile":7458.0,"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":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":2830.77,"10th_percentile":2826.9,"90th_percentile":2831.21,"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":"Blue Cross","plan_name":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"11","median_amount":6659.85,"10th_percentile":6193.0,"90th_percentile":8911.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"1 through 10","median_amount":20536.09,"10th_percentile":15347.14,"90th_percentile":22398.84},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"1 through 10","median_amount":13114.22,"10th_percentile":13114.22,"90th_percentile":13114.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":2855.17,"10th_percentile":2845.57,"90th_percentile":2855.85,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":1535.86,"10th_percentile":1535.86,"90th_percentile":1535.86,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":1206.07,"10th_percentile":1206.07,"90th_percentile":1206.07,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":10893.0,"10th_percentile":10893.0,"90th_percentile":10893.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"1 through 10","median_amount":8396.04,"10th_percentile":8396.04,"90th_percentile":8575.84,"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":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"12","median_amount":2847.07,"10th_percentile":2843.57,"90th_percentile":2903.12,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"1 through 10","median_amount":2934.02,"10th_percentile":2934.02,"90th_percentile":2934.02,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"11","median_amount":2850.57,"10th_percentile":2847.47,"90th_percentile":3033.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 1 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5091","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"12","median_amount":8063.2,"10th_percentile":7017.78,"90th_percentile":8639.86,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 100% of Medicare]","count":"16","median_amount":3963.97,"10th_percentile":3774.56,"90th_percentile":5888.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"1 through 10","median_amount":19454.85,"10th_percentile":19454.85,"90th_percentile":19454.85},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":11577.6,"10th_percentile":7687.5,"90th_percentile":23320.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":20404.06,"10th_percentile":20404.06,"90th_percentile":23183.09},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"1 through 10","median_amount":9088.34,"10th_percentile":8648.44,"90th_percentile":15193.21,"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":"Blue Cross","plan_name":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"1 through 10","median_amount":8911.0,"10th_percentile":6860.79,"90th_percentile":10445.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":7858.0,"10th_percentile":7858.0,"90th_percentile":7858.0,"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":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":7858.0,"10th_percentile":7858.0,"90th_percentile":7858.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month 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 ($): 100% of Medicare]","count":"1 through 10","median_amount":3981.51,"10th_percentile":3974.63,"90th_percentile":6636.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"1 through 10","median_amount":8911.0,"10th_percentile":8911.0,"90th_percentile":9435.0,"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":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"1 through 10","median_amount":27284.19,"10th_percentile":20371.65,"90th_percentile":45750.69},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"1 through 10","median_amount":13182.85,"10th_percentile":6637.82,"90th_percentile":23136.39},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"13","median_amount":3995.63,"10th_percentile":3483.49,"90th_percentile":7611.14,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":2886.9,"10th_percentile":2886.9,"90th_percentile":2886.9,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":3424.19,"10th_percentile":3424.19,"90th_percentile":3424.19,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":7807.0,"10th_percentile":7262.0,"90th_percentile":11710.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"1 through 10","median_amount":12435.68,"10th_percentile":12435.68,"90th_percentile":12435.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"17","median_amount":4072.58,"10th_percentile":3811.95,"90th_percentile":6689.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"11","median_amount":3994.39,"10th_percentile":354.21,"90th_percentile":4008.44,"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."}]}]},{"description":"Level 2 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5092","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"1 through 10","median_amount":13489.36,"10th_percentile":12005.96,"90th_percentile":13863.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":6612.59,"10th_percentile":5885.92,"90th_percentile":10683.47,"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":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"1 through 10","median_amount":16682.69,"10th_percentile":6185.45,"90th_percentile":41506.37},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":20930.43,"10th_percentile":18663.64,"90th_percentile":23003.12,"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":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"13","median_amount":30412.43,"10th_percentile":29357.31,"90th_percentile":57500.94},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"1 through 10","median_amount":14728.75,"10th_percentile":14728.75,"90th_percentile":15168.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"1 through 10","median_amount":8711.0,"10th_percentile":7126.81,"90th_percentile":13145.0,"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":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":7858.0,"10th_percentile":7858.0,"90th_percentile":25656.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":6630.48,"10th_percentile":6630.48,"90th_percentile":6630.48,"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":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"1 through 10","median_amount":8911.0,"10th_percentile":3366.29,"90th_percentile":28216.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"1 through 10","median_amount":40212.45,"10th_percentile":33980.13,"90th_percentile":40930.28},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":5946.25,"10th_percentile":285.0,"90th_percentile":5947.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":41797.35,"10th_percentile":41797.35,"90th_percentile":41797.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"1 through 10","median_amount":14200.0,"10th_percentile":14200.0,"90th_percentile":14200.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":6611.57,"10th_percentile":6611.57,"90th_percentile":7006.5,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":6685.0,"10th_percentile":6685.0,"90th_percentile":6685.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 3 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5093","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 100% of Medicare]","count":"1 through 10","median_amount":10131.26,"10th_percentile":10131.26,"90th_percentile":10131.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"1 through 10","median_amount":19158.2,"10th_percentile":19158.2,"90th_percentile":41158.92},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":22461.15,"10th_percentile":22461.15,"90th_percentile":22461.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month 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 ($): 100% of Medicare]","count":"1 through 10","median_amount":9451.54,"10th_percentile":9451.54,"90th_percentile":9451.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"1 through 10","median_amount":11276.2,"10th_percentile":10093.6,"90th_percentile":29074.6,"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":"Blue Cross","plan_name":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"1 through 10","median_amount":48060.8,"10th_percentile":48060.8,"90th_percentile":48060.8},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":8593.67,"10th_percentile":8593.67,"90th_percentile":9546.05,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":14554.52,"10th_percentile":14554.52,"90th_percentile":14554.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":9736.79,"10th_percentile":9736.79,"90th_percentile":9736.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":9901.27,"10th_percentile":9901.27,"90th_percentile":9901.27,"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 4 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5094","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":17323.91,"10th_percentile":17323.91,"90th_percentile":17323.91,"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":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":66444.46,"10th_percentile":66444.46,"90th_percentile":66444.46},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"1 through 10","median_amount":13981.0,"10th_percentile":13981.0,"90th_percentile":20559.0,"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":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"1 through 10","median_amount":19695.0,"10th_percentile":19695.0,"90th_percentile":19695.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"1 through 10","median_amount":391.22,"10th_percentile":391.22,"90th_percentile":391.22},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"1 through 10","median_amount":25751.77,"10th_percentile":25751.77,"90th_percentile":25751.77},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":24805.5,"10th_percentile":24805.5,"90th_percentile":24805.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Strapping and Cast Application","code_information":[{"code":"5101","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 100% of Medicare]","count":"1 through 10","median_amount":310.44,"10th_percentile":281.99,"90th_percentile":1552.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"1 through 10","median_amount":284.3,"10th_percentile":284.3,"90th_percentile":284.3},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"30","median_amount":318.0,"10th_percentile":318.0,"90th_percentile":1826.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":318.0,"10th_percentile":318.0,"90th_percentile":318.0,"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":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":318.0,"10th_percentile":318.0,"90th_percentile":318.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month 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 ($): 100% of Medicare]","count":"1 through 10","median_amount":594.87,"10th_percentile":307.58,"90th_percentile":932.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"1 through 10","median_amount":656.52,"10th_percentile":656.52,"90th_percentile":656.52},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":236.07,"10th_percentile":158.57,"90th_percentile":602.19,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":319.94,"10th_percentile":319.94,"90th_percentile":319.94,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"1 through 10","median_amount":305.28,"10th_percentile":305.28,"90th_percentile":689.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"13","median_amount":290.62,"10th_percentile":159.97,"90th_percentile":570.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":284.82,"10th_percentile":284.82,"90th_percentile":284.82,"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."}]}]},{"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":489.11,"10th_percentile":489.11,"90th_percentile":489.11,"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":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"1 through 10","median_amount":899.44,"10th_percentile":899.44,"90th_percentile":899.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"1 through 10","median_amount":1963.0,"10th_percentile":1963.0,"90th_percentile":1963.0,"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":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"1 through 10","median_amount":1398.5,"10th_percentile":1398.5,"90th_percentile":1398.5},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":243.2,"10th_percentile":243.2,"90th_percentile":243.2,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","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":493.44,"10th_percentile":493.44,"90th_percentile":493.44,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":493.44,"10th_percentile":493.44,"90th_percentile":493.44,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":493.44,"10th_percentile":493.44,"90th_percentile":508.57,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Musculoskeletal Procedures","code_information":[{"code":"5112","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"1 through 10","median_amount":3212.92,"10th_percentile":3212.92,"90th_percentile":3212.92,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"1 through 10","median_amount":883.89,"10th_percentile":883.89,"90th_percentile":883.89,"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] [APC ($): 100% of Medicare]","count":"12","median_amount":1575.83,"10th_percentile":1574.33,"90th_percentile":1577.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"1 through 10","median_amount":7273.2,"10th_percentile":1576.83,"90th_percentile":16659.0},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":7137.6,"10th_percentile":7137.6,"90th_percentile":7137.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":7350.93,"10th_percentile":5260.94,"90th_percentile":10062.11},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"1 through 10","median_amount":3614.54,"10th_percentile":3614.54,"90th_percentile":3616.79,"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":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"12","median_amount":5181.98,"10th_percentile":4793.0,"90th_percentile":5482.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":4228.0,"10th_percentile":4228.0,"90th_percentile":4477.0,"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":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month 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 ($): 100% of Medicare]","count":"1 through 10","median_amount":1580.76,"10th_percentile":1580.76,"90th_percentile":1580.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"1 through 10","median_amount":4793.0,"10th_percentile":4228.0,"90th_percentile":5075.0,"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":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"1 through 10","median_amount":8528.93,"10th_percentile":6539.81,"90th_percentile":20883.29},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":1595.97,"10th_percentile":180.24,"90th_percentile":1608.32,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":16352.79,"10th_percentile":16352.79,"90th_percentile":16352.79},{"payer_name":"Molina","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":493.44,"10th_percentile":493.44,"90th_percentile":584.45,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":508.57,"10th_percentile":493.44,"90th_percentile":858.15,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":508.57,"10th_percentile":508.57,"90th_percentile":715.63,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"14","median_amount":2597.0,"10th_percentile":2597.0,"90th_percentile":2800.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"1 through 10","median_amount":4285.12,"10th_percentile":4285.12,"90th_percentile":4285.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"21","median_amount":1622.52,"10th_percentile":1591.57,"90th_percentile":1622.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"11","median_amount":1592.57,"10th_percentile":1467.12,"90th_percentile":1690.47,"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."}]}]},{"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"1 through 10","median_amount":6513.74,"10th_percentile":6513.74,"90th_percentile":6894.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"1 through 10","median_amount":2132.53,"10th_percentile":2132.53,"90th_percentile":2132.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"21","median_amount":3197.23,"10th_percentile":2925.08,"90th_percentile":3198.25,"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":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"1 through 10","median_amount":11676.0,"10th_percentile":3953.4,"90th_percentile":24966.02},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":10790.55,"10th_percentile":8420.1,"90th_percentile":15337.94,"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":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":19916.72,"10th_percentile":17413.27,"90th_percentile":23492.95},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"13","median_amount":7327.96,"10th_percentile":7327.96,"90th_percentile":16134.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"29","median_amount":8911.0,"10th_percentile":7128.8,"90th_percentile":11163.6,"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":"Blue Cross","plan_name":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":7858.0,"10th_percentile":7044.0,"90th_percentile":14904.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. 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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":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"11","median_amount":3204.76,"10th_percentile":3204.76,"90th_percentile":3302.09,"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":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"24","median_amount":8911.0,"10th_percentile":7788.0,"90th_percentile":10445.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"11","median_amount":17833.89,"10th_percentile":11324.57,"90th_percentile":34077.42},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"1 through 10","median_amount":15010.61,"10th_percentile":14764.05,"90th_percentile":15795.72},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"21","median_amount":3230.05,"10th_percentile":2959.17,"90th_percentile":3368.35,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":1393.51,"10th_percentile":1393.51,"90th_percentile":1393.51,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":1565.78,"10th_percentile":1393.51,"90th_percentile":3726.16,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"14","median_amount":9358.0,"10th_percentile":7262.0,"90th_percentile":14037.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"1 through 10","median_amount":8143.92,"10th_percentile":7468.8,"90th_percentile":8238.66,"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":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"23","median_amount":3231.27,"10th_percentile":3223.66,"90th_percentile":3289.44,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"15","median_amount":3230.65,"10th_percentile":3227.55,"90th_percentile":3328.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 4 Musculoskeletal Procedures","code_information":[{"code":"5114","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"16","median_amount":14342.68,"10th_percentile":13171.34,"90th_percentile":25830.92,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":23212.32,"10th_percentile":23212.32,"90th_percentile":23212.32},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"1 through 10","median_amount":3837.95,"10th_percentile":3837.95,"90th_percentile":7403.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"18","median_amount":14341.46,"10th_percentile":5736.58,"90th_percentile":19987.15},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"16","median_amount":15187.96,"10th_percentile":11820.9,"90th_percentile":21623.08,"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":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"14","median_amount":29446.9,"10th_percentile":20784.52,"90th_percentile":35300.94},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"33","median_amount":16134.14,"10th_percentile":16134.14,"90th_percentile":29059.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"39","median_amount":12690.4,"10th_percentile":9745.0,"90th_percentile":16897.0,"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":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"20","median_amount":11096.2,"10th_percentile":7858.0,"90th_percentile":20751.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":9516.4,"10th_percentile":7858.0,"90th_percentile":11480.2,"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":"Blue Cross","plan_name":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"14","median_amount":7056.0,"10th_percentile":250.0,"90th_percentile":7544.12,"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":"Blue Cross","plan_name":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"56","median_amount":10714.0,"10th_percentile":7128.84,"90th_percentile":15801.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"39","median_amount":26378.69,"10th_percentile":3522.48,"90th_percentile":43726.53},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"1 through 10","median_amount":15174.59,"10th_percentile":7066.61,"90th_percentile":21730.04},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":6465.56,"10th_percentile":6465.56,"90th_percentile":6465.56,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"28","median_amount":7103.49,"10th_percentile":509.78,"90th_percentile":7290.07,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":41341.84,"10th_percentile":41341.84,"90th_percentile":41341.84},{"payer_name":"Molina","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":3616.17,"10th_percentile":3616.17,"90th_percentile":3616.17,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":3864.23,"10th_percentile":3490.0,"90th_percentile":4558.08,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"13","median_amount":3716.6,"10th_percentile":3490.0,"90th_percentile":5200.24,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"39","median_amount":16537.0,"10th_percentile":1741.0,"90th_percentile":24805.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"13","median_amount":13004.41,"10th_percentile":7757.04,"90th_percentile":14200.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":24805.5,"10th_percentile":24805.5,"90th_percentile":24805.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"61","median_amount":7104.6,"10th_percentile":6524.1,"90th_percentile":7439.91,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"1 through 10","median_amount":7529.26,"10th_percentile":7529.26,"90th_percentile":7529.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"25","median_amount":7104.59,"10th_percentile":6524.1,"90th_percentile":7105.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 5 Musculoskeletal Procedures","code_information":[{"code":"5115","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"16","median_amount":26029.44,"10th_percentile":25048.4,"90th_percentile":26702.88,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 100% of Medicare]","count":"173","median_amount":12760.17,"10th_percentile":275.0,"90th_percentile":13069.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"23","median_amount":19091.7,"10th_percentile":3339.44,"90th_percentile":31556.45},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"21","median_amount":17733.03,"10th_percentile":249.9,"90th_percentile":25383.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"21","median_amount":30397.41,"10th_percentile":19351.43,"90th_percentile":46669.32},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"12","median_amount":29283.89,"10th_percentile":29059.79,"90th_percentile":29350.46,"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":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"53","median_amount":16274.2,"10th_percentile":13782.8,"90th_percentile":19288.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"25","median_amount":15233.2,"10th_percentile":11686.0,"90th_percentile":24677.8,"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":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"21","median_amount":16613.2,"10th_percentile":9645.33,"90th_percentile":21564.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month 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 ($): 100% of Medicare]","count":"56","median_amount":13000.02,"10th_percentile":12044.34,"90th_percentile":13197.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"63","median_amount":15693.4,"10th_percentile":2175.94,"90th_percentile":24856.66,"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":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"1 through 10","median_amount":15738.8,"10th_percentile":15738.8,"90th_percentile":15738.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"25","median_amount":34311.32,"10th_percentile":1366.37,"90th_percentile":48613.98},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"1 through 10","median_amount":19453.03,"10th_percentile":6620.68,"90th_percentile":50849.48},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":13170.28,"10th_percentile":13170.28,"90th_percentile":13170.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"101","median_amount":12889.62,"10th_percentile":225.0,"90th_percentile":13294.06,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":36577.73,"10th_percentile":36577.73,"90th_percentile":36577.73},{"payer_name":"Molina","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":6459.86,"10th_percentile":6459.86,"90th_percentile":6459.86,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":7309.88,"10th_percentile":7309.88,"90th_percentile":7309.88,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":4942.91,"10th_percentile":4942.91,"90th_percentile":6202.53,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"30","median_amount":19735.5,"10th_percentile":2235.14,"90th_percentile":34027.08,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"16","median_amount":17577.54,"10th_percentile":8033.0,"90th_percentile":21643.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"74","median_amount":13195.18,"10th_percentile":2694.39,"90th_percentile":13462.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"46","median_amount":12889.61,"10th_percentile":587.78,"90th_percentile":13297.6,"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."}]}]},{"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"1 through 10","median_amount":37303.5,"10th_percentile":37303.5,"90th_percentile":37303.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"17","median_amount":18095.87,"10th_percentile":16812.3,"90th_percentile":18209.85,"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":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"1 through 10","median_amount":18772.17,"10th_percentile":5130.6,"90th_percentile":25766.1},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":20254.35,"10th_percentile":19416.78,"90th_percentile":25325.87,"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":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"1 through 10","median_amount":41553.94,"10th_percentile":41553.94,"90th_percentile":41553.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"1 through 10","median_amount":21794.8,"10th_percentile":21794.8,"90th_percentile":25125.8,"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":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":31736.8,"10th_percentile":31736.8,"90th_percentile":31736.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"11","median_amount":18164.21,"10th_percentile":16880.92,"90th_percentile":18565.87,"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":"Blue Cross","plan_name":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"1 through 10","median_amount":22335.2,"10th_percentile":13974.6,"90th_percentile":31034.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"1 through 10","median_amount":53568.94,"10th_percentile":53568.94,"90th_percentile":65109.14},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"1 through 10","median_amount":31446.28,"10th_percentile":31446.28,"90th_percentile":31446.28},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"16","median_amount":18279.28,"10th_percentile":17100.13,"90th_percentile":18511.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":53148.13,"10th_percentile":53148.13,"90th_percentile":53148.13},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":16996.5,"10th_percentile":15383.0,"90th_percentile":59325.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":18278.58,"10th_percentile":17115.6,"90th_percentile":18376.41,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"12","median_amount":18278.28,"10th_percentile":17290.49,"90th_percentile":18376.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 2 Airway Endoscopy","code_information":[{"code":"5152","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 100% of Medicare]","count":"1 through 10","median_amount":383.15,"10th_percentile":383.15,"90th_percentile":383.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month 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 ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"1 through 10","median_amount":1511.0,"10th_percentile":1511.0,"90th_percentile":1511.0,"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":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":385.88,"10th_percentile":385.88,"90th_percentile":385.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":393.68,"10th_percentile":393.68,"90th_percentile":393.68,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":593.83,"10th_percentile":593.83,"90th_percentile":593.83,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":392.81,"10th_percentile":389.31,"90th_percentile":579.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":464.67,"10th_percentile":464.67,"90th_percentile":464.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 3 Airway Endoscopy","code_information":[{"code":"5153","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"15","median_amount":1697.75,"10th_percentile":290.0,"90th_percentile":1702.17,"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":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"1 through 10","median_amount":1329.0,"10th_percentile":1318.2,"90th_percentile":1881.0},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":13907.31,"10th_percentile":13907.31,"90th_percentile":13907.31},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"1 through 10","median_amount":3894.73,"10th_percentile":3894.73,"90th_percentile":3894.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"1 through 10","median_amount":2787.5,"10th_percentile":1703.29,"90th_percentile":4385.6,"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":"Blue Cross","plan_name":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":4228.0,"10th_percentile":4228.0,"90th_percentile":4477.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":4228.0,"10th_percentile":4228.0,"90th_percentile":4228.0,"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":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":1703.29,"10th_percentile":1545.16,"90th_percentile":1703.29,"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":"Blue Cross","plan_name":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"1 through 10","median_amount":5075.0,"10th_percentile":4793.0,"90th_percentile":5075.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":1719.83,"10th_percentile":1552.98,"90th_percentile":1733.8,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":13539.37,"10th_percentile":13539.37,"90th_percentile":13539.37},{"payer_name":"Molina","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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":2227.73,"10th_percentile":2227.73,"90th_percentile":2227.73,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":1213.44,"10th_percentile":1213.44,"90th_percentile":1213.44,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":4107.0,"10th_percentile":4107.0,"90th_percentile":4107.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"12","median_amount":1715.24,"10th_percentile":1585.98,"90th_percentile":1748.3,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":1720.33,"10th_percentile":1552.08,"90th_percentile":3667.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 4 Airway Endoscopy","code_information":[{"code":"5154","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"1 through 10","median_amount":12601.02,"10th_percentile":12601.02,"90th_percentile":13897.28,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 100% of Medicare]","count":"26","median_amount":6809.67,"10th_percentile":3626.87,"90th_percentile":6817.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"1 through 10","median_amount":7662.0,"10th_percentile":7662.0,"90th_percentile":7662.0},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":14345.59,"10th_percentile":14345.59,"90th_percentile":14345.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":18259.43,"10th_percentile":18259.43,"90th_percentile":18259.43},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"1 through 10","median_amount":8327.0,"10th_percentile":8327.0,"90th_percentile":15634.44,"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":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"1 through 10","median_amount":8911.0,"10th_percentile":8019.9,"90th_percentile":11065.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":7858.0,"10th_percentile":7858.0,"90th_percentile":7858.0,"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":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month 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 ($): 100% of Medicare]","count":"15","median_amount":6199.7,"10th_percentile":3641.68,"90th_percentile":6837.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"1 through 10","median_amount":8911.0,"10th_percentile":8711.0,"90th_percentile":8911.0,"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":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"1 through 10","median_amount":17516.28,"10th_percentile":17516.28,"90th_percentile":30463.74},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"16","median_amount":6882.27,"10th_percentile":3667.64,"90th_percentile":6889.66,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":26111.1,"10th_percentile":26111.1,"90th_percentile":26111.1},{"payer_name":"Molina","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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":2487.33,"10th_percentile":2487.33,"90th_percentile":2487.33,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":10074.0,"10th_percentile":8631.0,"90th_percentile":12336.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"1 through 10","median_amount":10517.93,"10th_percentile":5072.28,"90th_percentile":12366.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"30","median_amount":6363.52,"10th_percentile":3665.21,"90th_percentile":7018.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"1 through 10","median_amount":7296.07,"10th_percentile":7296.07,"90th_percentile":7296.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"1 through 10","median_amount":7110.96,"10th_percentile":7110.96,"90th_percentile":7110.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"13","median_amount":6881.67,"10th_percentile":6240.15,"90th_percentile":6884.77,"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."}]}]},{"description":"Level 5 Airway Endoscopy","code_information":[{"code":"5155","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"1 through 10","median_amount":13897.28,"10th_percentile":13897.28,"90th_percentile":13897.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"16","median_amount":6813.17,"10th_percentile":6179.5,"90th_percentile":6815.47,"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":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"1 through 10","median_amount":6837.46,"10th_percentile":6837.46,"90th_percentile":6837.46},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":14356.05,"10th_percentile":13831.97,"90th_percentile":14931.76,"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":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":26621.15,"10th_percentile":24224.58,"90th_percentile":29444.05},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"1 through 10","median_amount":15634.44,"10th_percentile":15634.44,"90th_percentile":15634.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"1 through 10","median_amount":10899.8,"10th_percentile":10899.8,"90th_percentile":10899.82,"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":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":8312.8,"10th_percentile":7858.0,"90th_percentile":63369.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":7858.0,"10th_percentile":7858.0,"90th_percentile":7858.0,"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":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":6837.46,"10th_percentile":6199.7,"90th_percentile":9540.02,"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":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"1 through 10","median_amount":9365.8,"10th_percentile":8911.0,"90th_percentile":10899.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"1 through 10","median_amount":1253.71,"10th_percentile":1253.71,"90th_percentile":30535.24},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"1 through 10","median_amount":19265.98,"10th_percentile":1121.4,"90th_percentile":19981.15},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":6813.57,"10th_percentile":6813.57,"90th_percentile":6813.57,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"23","median_amount":6883.67,"10th_percentile":6511.45,"90th_percentile":6889.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":24168.63,"10th_percentile":24168.63,"90th_percentile":24168.63},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":10893.0,"10th_percentile":10893.0,"90th_percentile":13057.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"1 through 10","median_amount":11692.68,"10th_percentile":11692.68,"90th_percentile":13364.64,"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":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"21","median_amount":6882.77,"10th_percentile":1403.63,"90th_percentile":7018.13,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"13","median_amount":6884.77,"10th_percentile":6240.15,"90th_percentile":6888.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 1 ENT Procedures","code_information":[{"code":"5161","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"1 through 10","median_amount":882.14,"10th_percentile":882.14,"90th_percentile":882.14,"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":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month 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 ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 ENT Procedures","code_information":[{"code":"5162","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":1142.22,"10th_percentile":1142.22,"90th_percentile":1142.22,"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":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":1724.64,"10th_percentile":1724.64,"90th_percentile":1724.64},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"1 through 10","median_amount":652.05,"10th_percentile":652.05,"90th_percentile":652.05,"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":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"1 through 10","median_amount":2299.69,"10th_percentile":2299.69,"90th_percentile":2299.69},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","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":99.37,"10th_percentile":99.37,"90th_percentile":99.37,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":100.31,"10th_percentile":100.31,"90th_percentile":119.15,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 ENT Procedures","code_information":[{"code":"5163","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 100% of Medicare]","count":"1 through 10","median_amount":1458.92,"10th_percentile":1458.92,"90th_percentile":1458.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month 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 ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":1474.21,"10th_percentile":1474.21,"90th_percentile":1474.21,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 ENT Procedures","code_information":[{"code":"5164","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"1 through 10","median_amount":6510.66,"10th_percentile":6510.66,"90th_percentile":6510.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":9252.74,"10th_percentile":8546.25,"90th_percentile":10854.15,"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":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"1 through 10","median_amount":7324.49,"10th_percentile":7324.49,"90th_percentile":7324.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"12","median_amount":7858.0,"10th_percentile":7044.0,"90th_percentile":7858.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":7044.0,"10th_percentile":7044.0,"90th_percentile":7044.0,"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":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":3203.24,"10th_percentile":3203.24,"90th_percentile":3203.24,"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":"Blue Cross","plan_name":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"1 through 10","median_amount":7988.0,"10th_percentile":7988.0,"90th_percentile":7988.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":3257.53,"10th_percentile":3257.03,"90th_percentile":3257.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 ENT Procedures","code_information":[{"code":"5165","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"1 through 10","median_amount":17563.15,"10th_percentile":17563.15,"90th_percentile":17563.15},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":8324.7,"10th_percentile":8324.7,"90th_percentile":8324.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":8911.0,"10th_percentile":8911.0,"90th_percentile":8911.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month 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 ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"1 through 10","median_amount":9435.0,"10th_percentile":9435.0,"90th_percentile":9435.0,"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":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":5883.35,"10th_percentile":5883.35,"90th_percentile":5883.35,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":13633.0,"10th_percentile":13633.0,"90th_percentile":13633.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":5885.76,"10th_percentile":5885.76,"90th_percentile":5885.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% 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":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"1 through 10","median_amount":1241.2,"10th_percentile":1241.2,"90th_percentile":1256.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"22","median_amount":611.89,"10th_percentile":608.19,"90th_percentile":2524.5,"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":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"1 through 10","median_amount":4118.4,"10th_percentile":4118.4,"90th_percentile":4118.4},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":2241.54,"10th_percentile":2241.54,"90th_percentile":10181.91},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"1 through 10","median_amount":1396.35,"10th_percentile":1396.35,"90th_percentile":1754.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"1 through 10","median_amount":2208.0,"10th_percentile":1464.4,"90th_percentile":2738.0,"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":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":2119.0,"10th_percentile":2119.0,"90th_percentile":2244.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":2119.0,"10th_percentile":2119.0,"90th_percentile":2119.0,"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":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":610.67,"10th_percentile":610.67,"90th_percentile":660.05,"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":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"1 through 10","median_amount":2402.0,"10th_percentile":2402.0,"90th_percentile":2901.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"1 through 10","median_amount":2726.32,"10th_percentile":2726.32,"90th_percentile":2726.32},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"24","median_amount":620.17,"10th_percentile":614.27,"90th_percentile":623.52,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":1.27,"10th_percentile":1.27,"90th_percentile":1.27,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":475.13,"10th_percentile":475.13,"90th_percentile":475.13,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":2135.0,"10th_percentile":1986.0,"90th_percentile":2135.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"1 through 10","median_amount":529.92,"10th_percentile":529.92,"90th_percentile":529.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"22","median_amount":623.87,"10th_percentile":584.08,"90th_percentile":1965.11,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"1 through 10","median_amount":593.4,"10th_percentile":593.4,"90th_percentile":593.4,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"15","median_amount":618.27,"10th_percentile":614.27,"90th_percentile":1653.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 2 Vascular Procedures","code_information":[{"code":"5182","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"1 through 10","median_amount":3118.62,"10th_percentile":3118.62,"90th_percentile":3134.34,"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":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 100% of Medicare]","count":"20","median_amount":1529.12,"10th_percentile":1448.5,"90th_percentile":1533.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"1 through 10","median_amount":2841.6,"10th_percentile":2251.8,"90th_percentile":2948.58},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":4288.8,"10th_percentile":4288.8,"90th_percentile":4288.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":2207.06,"10th_percentile":2206.83,"90th_percentile":2763.47},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"1 through 10","median_amount":3317.15,"10th_percentile":3317.15,"90th_percentile":3508.45,"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":"Blue Cross","plan_name":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"11","median_amount":4793.0,"10th_percentile":3993.0,"90th_percentile":5482.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":4228.0,"10th_percentile":4056.0,"90th_percentile":4477.0,"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":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":4228.0,"10th_percentile":4228.0,"90th_percentile":4228.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month 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 ($): 100% of Medicare]","count":"1 through 10","median_amount":1450.7,"10th_percentile":1450.7,"90th_percentile":1450.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"12","median_amount":4055.0,"10th_percentile":3982.0,"90th_percentile":4793.0,"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":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"1 through 10","median_amount":3289.8,"10th_percentile":2529.52,"90th_percentile":11177.62},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"18","median_amount":1547.0,"10th_percentile":1543.4,"90th_percentile":1554.8,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":755.68,"10th_percentile":473.86,"90th_percentile":1286.76,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":2738.0,"10th_percentile":2597.0,"90th_percentile":2943.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"1 through 10","median_amount":1181.28,"10th_percentile":1181.28,"90th_percentile":4308.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"31","median_amount":1543.41,"10th_percentile":1464.85,"90th_percentile":1574.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"11","median_amount":1550.4,"10th_percentile":1464.85,"90th_percentile":1551.3,"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":"Level 3 Vascular Procedures","code_information":[{"code":"5183","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"1 through 10","median_amount":6318.8,"10th_percentile":6318.8,"90th_percentile":6334.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"47","median_amount":3099.01,"10th_percentile":2881.06,"90th_percentile":3102.53,"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":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"1 through 10","median_amount":6614.4,"10th_percentile":6015.6,"90th_percentile":13878.0},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":8898.6,"10th_percentile":5331.0,"90th_percentile":11069.16,"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":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"11","median_amount":9748.69,"10th_percentile":6241.39,"90th_percentile":13711.27},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"21","median_amount":7108.65,"10th_percentile":6602.04,"90th_percentile":7117.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"1 through 10","median_amount":8637.99,"10th_percentile":7044.0,"90th_percentile":9138.0,"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":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"28","median_amount":7044.0,"10th_percentile":7044.0,"90th_percentile":7458.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":7044.0,"10th_percentile":7044.0,"90th_percentile":7516.2,"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":"Blue Cross","plan_name":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"19","median_amount":3108.85,"10th_percentile":2895.03,"90th_percentile":3116.59,"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":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"20","median_amount":7988.0,"10th_percentile":7044.0,"90th_percentile":8460.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"1 through 10","median_amount":7988.0,"10th_percentile":7988.0,"90th_percentile":7988.0,"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":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"1 through 10","median_amount":10282.71,"10th_percentile":7143.06,"90th_percentile":21161.93},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"1 through 10","median_amount":11240.71,"10th_percentile":11240.71,"90th_percentile":11240.71},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"1 through 10","median_amount":11996.0,"10th_percentile":11996.0,"90th_percentile":11996.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":3096.21,"10th_percentile":3096.21,"90th_percentile":3096.21,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"30","median_amount":3133.07,"10th_percentile":2908.81,"90th_percentile":3158.14,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":5478.07,"10th_percentile":5478.07,"90th_percentile":5478.07},{"payer_name":"Molina","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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":2374.44,"10th_percentile":2374.44,"90th_percentile":2374.44,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":2056.78,"10th_percentile":1381.01,"90th_percentile":2566.96,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"13","median_amount":8705.0,"10th_percentile":2665.68,"90th_percentile":13057.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"13","median_amount":3024.7,"10th_percentile":1095.31,"90th_percentile":9427.78,"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":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"47","median_amount":3134.18,"10th_percentile":2963.58,"90th_percentile":3237.76,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"1 through 10","median_amount":3233.21,"10th_percentile":3233.21,"90th_percentile":3233.21,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":3131.07,"10th_percentile":2909.91,"90th_percentile":3134.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 4 Vascular Procedures","code_information":[{"code":"5184","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"1 through 10","median_amount":10117.48,"10th_percentile":10117.48,"90th_percentile":10117.48,"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":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 100% of Medicare]","count":"1 through 10","median_amount":5317.61,"10th_percentile":4963.07,"90th_percentile":5325.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"1 through 10","median_amount":20455.8,"10th_percentile":20455.8,"90th_percentile":20455.8},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":5414.7,"10th_percentile":5414.7,"90th_percentile":5414.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"1 through 10","median_amount":12208.79,"10th_percentile":12208.79,"90th_percentile":12208.79,"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":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"1 through 10","median_amount":133.87,"10th_percentile":133.87,"90th_percentile":133.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":8831.8,"10th_percentile":7858.0,"90th_percentile":9773.8,"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":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":8320.0,"10th_percentile":8320.0,"90th_percentile":9295.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month 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 ($): 100% of Medicare]","count":"1 through 10","median_amount":4985.54,"10th_percentile":4977.8,"90th_percentile":5339.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"1 through 10","median_amount":8911.0,"10th_percentile":8911.0,"90th_percentile":10348.6,"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":"Blue Cross","plan_name":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"1 through 10","median_amount":8745.11,"10th_percentile":8330.65,"90th_percentile":11331.96},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"1 through 10","median_amount":10836.38,"10th_percentile":10836.38,"90th_percentile":10836.38},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":5376.68,"10th_percentile":5014.92,"90th_percentile":5392.7,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":17487.0,"10th_percentile":17487.0,"90th_percentile":17487.0},{"payer_name":"Molina","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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":16537.0,"10th_percentile":10949.14,"90th_percentile":23074.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"21","median_amount":5378.59,"10th_percentile":5011.05,"90th_percentile":5488.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 104% of Medicare]","count":"1 through 10","median_amount":5536.32,"10th_percentile":5536.32,"90th_percentile":5536.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":5377.78,"10th_percentile":5377.78,"90th_percentile":5377.78,"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."}]}]},{"description":"Level 1 Endovascular Procedures","code_information":[{"code":"5191","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"1 through 10","median_amount":6457.14,"10th_percentile":5999.34,"90th_percentile":11446.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"109","median_amount":3169.5,"10th_percentile":2952.8,"90th_percentile":5614.11,"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":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"11","median_amount":10530.96,"10th_percentile":2112.39,"90th_percentile":16127.4},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":9848.4,"10th_percentile":7580.4,"90th_percentile":18791.12,"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":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":13342.03,"10th_percentile":10021.33,"90th_percentile":18420.72},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"14","median_amount":7264.28,"10th_percentile":8.84,"90th_percentile":12915.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"21","median_amount":12773.0,"10th_percentile":10234.0,"90th_percentile":14620.0,"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":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"31","median_amount":11261.0,"10th_percentile":11261.0,"90th_percentile":11923.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":11261.0,"10th_percentile":11261.0,"90th_percentile":11923.0,"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":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"28","median_amount":3176.91,"10th_percentile":2951.68,"90th_percentile":5631.5,"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":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"25","median_amount":12773.0,"10th_percentile":9466.8,"90th_percentile":13857.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"14","median_amount":16855.86,"10th_percentile":3776.43,"90th_percentile":27994.89},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"1 through 10","median_amount":5958.36,"10th_percentile":5958.36,"90th_percentile":11973.26},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":3167.9,"10th_percentile":3167.9,"90th_percentile":3171.75,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"89","median_amount":3205.43,"10th_percentile":3015.45,"90th_percentile":5673.08,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":14501.13,"10th_percentile":14501.13,"90th_percentile":19717.85},{"payer_name":"Molina","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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":1588.63,"10th_percentile":1588.63,"90th_percentile":1592.85,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"21","median_amount":10429.5,"10th_percentile":10002.0,"90th_percentile":10752.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"12","median_amount":5489.76,"10th_percentile":3203.45,"90th_percentile":10891.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":10429.5,"10th_percentile":10429.5,"90th_percentile":10429.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"99","median_amount":3203.55,"10th_percentile":2981.08,"90th_percentile":5677.95,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"1 through 10","median_amount":6009.22,"10th_percentile":6009.22,"90th_percentile":6009.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"1 through 10","median_amount":3294.56,"10th_percentile":3294.56,"90th_percentile":3294.56,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"51","median_amount":3203.43,"10th_percentile":3195.64,"90th_percentile":5671.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 2 Endovascular Procedures","code_information":[{"code":"5192","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"1 through 10","median_amount":5727.0,"10th_percentile":5727.0,"90th_percentile":10530.96,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 100% of Medicare]","count":"13","median_amount":5608.61,"10th_percentile":5608.61,"90th_percentile":5614.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":20320.5,"10th_percentile":20320.5,"90th_percentile":20320.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"1 through 10","median_amount":27412.0,"10th_percentile":27412.0,"90th_percentile":27412.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":11261.0,"10th_percentile":8320.0,"90th_percentile":12293.0,"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":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":7858.0,"10th_percentile":7858.0,"90th_percentile":11048.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month 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 ($): 100% of Medicare]","count":"1 through 10","median_amount":5631.5,"10th_percentile":5631.5,"90th_percentile":5631.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"1 through 10","median_amount":12773.0,"10th_percentile":12773.0,"90th_percentile":12773.0,"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":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"1 through 10","median_amount":16391.58,"10th_percentile":16391.58,"90th_percentile":16391.58},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":5616.36,"10th_percentile":5616.36,"90th_percentile":5616.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":5670.59,"10th_percentile":5669.19,"90th_percentile":5691.71,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","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":6410.57,"10th_percentile":6410.57,"90th_percentile":6410.57,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":7702.98,"10th_percentile":7702.98,"90th_percentile":7702.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"1 through 10","median_amount":3896.58,"10th_percentile":3896.58,"90th_percentile":3896.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"27","median_amount":5780.3,"10th_percentile":5322.11,"90th_percentile":5780.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":5664.69,"10th_percentile":5211.77,"90th_percentile":5671.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 3 Endovascular Procedures","code_information":[{"code":"5193","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"1 through 10","median_amount":22766.88,"10th_percentile":22766.88,"90th_percentile":22774.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"35","median_amount":11161.27,"10th_percentile":13.39,"90th_percentile":11176.68,"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":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"1 through 10","median_amount":15710.4,"10th_percentile":15710.4,"90th_percentile":15710.4},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":21164.72,"10th_percentile":21164.72,"90th_percentile":21164.72,"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":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":37947.37,"10th_percentile":37947.37,"90th_percentile":37947.37},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"1 through 10","median_amount":100.64,"10th_percentile":30.13,"90th_percentile":25642.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"1 through 10","median_amount":26935.0,"10th_percentile":15275.29,"90th_percentile":29566.6,"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":"Blue Cross","plan_name":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"12","median_amount":22547.0,"10th_percentile":13013.92,"90th_percentile":23495.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":25459.0,"10th_percentile":25459.0,"90th_percentile":25459.0,"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":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"13","median_amount":11201.3,"10th_percentile":11201.3,"90th_percentile":11233.82,"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":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"16","median_amount":25459.0,"10th_percentile":12658.6,"90th_percentile":28975.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"1 through 10","median_amount":24979.13,"10th_percentile":1208.63,"90th_percentile":45915.59},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"1 through 10","median_amount":20132.62,"10th_percentile":20132.62,"90th_percentile":20132.62},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":15280.22,"10th_percentile":15280.22,"90th_percentile":15280.22,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"44","median_amount":11277.11,"10th_percentile":10033.4,"90th_percentile":11313.31,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":5577.1,"10th_percentile":5577.1,"90th_percentile":5577.1,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"11","median_amount":32370.5,"10th_percentile":4847.35,"90th_percentile":39715.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"1 through 10","median_amount":13720.0,"10th_percentile":13720.0,"90th_percentile":13720.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"53","median_amount":11274.23,"10th_percentile":10033.32,"90th_percentile":11501.24,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"1 through 10","median_amount":10330.56,"10th_percentile":10330.56,"90th_percentile":10330.56,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"24","median_amount":11274.32,"10th_percentile":11267.32,"90th_percentile":11289.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 4 Endovascular Procedures","code_information":[{"code":"5194","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"1 through 10","median_amount":36049.2,"10th_percentile":36049.2,"90th_percentile":36049.2,"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":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 100% of Medicare]","count":"20","median_amount":17667.61,"10th_percentile":15836.42,"90th_percentile":17690.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"1 through 10","median_amount":20750.06,"10th_percentile":20750.06,"90th_percentile":20750.06},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"1 through 10","median_amount":40555.35,"10th_percentile":40555.35,"90th_percentile":40555.35,"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":"Blue Cross","plan_name":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"1 through 10","median_amount":14470.0,"10th_percentile":14470.0,"90th_percentile":14470.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":11261.0,"10th_percentile":9944.5,"90th_percentile":12859.4,"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":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month 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 ($): 100% of Medicare]","count":"1 through 10","median_amount":15883.66,"10th_percentile":15883.66,"90th_percentile":17736.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"1 through 10","median_amount":12773.0,"10th_percentile":12773.0,"90th_percentile":24113.0,"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":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"1 through 10","median_amount":63936.78,"10th_percentile":63936.78,"90th_percentile":63936.78},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"1 through 10","median_amount":27440.13,"10th_percentile":27440.13,"90th_percentile":27440.13},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":17848.75,"10th_percentile":17846.65,"90th_percentile":17855.26,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":6999.91,"10th_percentile":6999.91,"90th_percentile":6999.91,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":39634.5,"10th_percentile":34798.5,"90th_percentile":85787.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"1 through 10","median_amount":13720.0,"10th_percentile":13720.0,"90th_percentile":13720.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"19","median_amount":17844.83,"10th_percentile":15977.29,"90th_percentile":18204.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":17844.65,"10th_percentile":15982.88,"90th_percentile":17851.64,"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."}]}]},{"description":"Implantation Wireless PA Pressure Monitor","code_information":[{"code":"5200","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":28248.62,"10th_percentile":28248.62,"90th_percentile":28248.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Electrophysiologic Procedures","code_information":[{"code":"5211","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month 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 ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":1106.54,"10th_percentile":1106.54,"90th_percentile":1106.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Electrophysiologic Procedures","code_information":[{"code":"5212","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"1 through 10","median_amount":13765.38,"10th_percentile":13765.38,"90th_percentile":13765.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":7469.94,"10th_percentile":7469.94,"90th_percentile":7469.94,"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":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":13725.52,"10th_percentile":13725.52,"90th_percentile":13725.52,"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":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"1 through 10","median_amount":17155.44,"10th_percentile":17155.44,"90th_percentile":17155.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"1 through 10","median_amount":25499.8,"10th_percentile":25499.8,"90th_percentile":25499.8,"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":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":24318.2,"10th_percentile":24318.2,"90th_percentile":24318.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"1 through 10","median_amount":30181.49,"10th_percentile":30181.49,"90th_percentile":30181.49},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":7547.09,"10th_percentile":7547.09,"90th_percentile":7547.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":7539.6,"10th_percentile":7539.6,"90th_percentile":7539.6,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":7546.09,"10th_percentile":7546.09,"90th_percentile":7546.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 3 Electrophysiologic Procedures","code_information":[{"code":"5213","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"12","median_amount":49250.06,"10th_percentile":43742.56,"90th_percentile":49257.92,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 100% of Medicare]","count":"84","median_amount":24138.03,"10th_percentile":21426.15,"90th_percentile":24141.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"13","median_amount":20946.0,"10th_percentile":658.8,"90th_percentile":55913.1},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":40411.35,"10th_percentile":22419.9,"90th_percentile":48741.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":37243.78,"10th_percentile":16145.53,"90th_percentile":61412.9},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"1 through 10","median_amount":55406.32,"10th_percentile":55406.32,"90th_percentile":55424.0,"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":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"32","median_amount":27412.0,"10th_percentile":24061.67,"90th_percentile":29163.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"21","median_amount":21677.0,"10th_percentile":21677.0,"90th_percentile":22952.0,"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":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":21677.0,"10th_percentile":21677.0,"90th_percentile":21677.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month 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 ($): 100% of Medicare]","count":"37","median_amount":24231.03,"10th_percentile":21521.35,"90th_percentile":24234.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"34","median_amount":24589.0,"10th_percentile":24120.83,"90th_percentile":27763.0,"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":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"12","median_amount":67005.04,"10th_percentile":20180.59,"90th_percentile":77415.65},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"1 through 10","median_amount":38723.71,"10th_percentile":38723.71,"90th_percentile":38723.71},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":24135.53,"10th_percentile":24135.53,"90th_percentile":24136.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"73","median_amount":24379.75,"10th_percentile":21650.0,"90th_percentile":24384.24,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":59133.32,"10th_percentile":59133.32,"90th_percentile":59133.32},{"payer_name":"Molina","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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":10917.63,"10th_percentile":10917.63,"90th_percentile":11098.19,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"33","median_amount":59325.5,"10th_percentile":56220.78,"90th_percentile":63774.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"1 through 10","median_amount":13720.0,"10th_percentile":13720.0,"90th_percentile":14200.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"87","median_amount":24380.86,"10th_percentile":21646.01,"90th_percentile":24871.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 104% of Medicare]","count":"1 through 10","median_amount":25097.83,"10th_percentile":25097.83,"90th_percentile":25097.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"69","median_amount":24380.85,"10th_percentile":21646.01,"90th_percentile":24388.63,"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."}]}]},{"description":"Level 1 Pacemaker and Similar Procedures","code_information":[{"code":"5221","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":3598.48,"10th_percentile":3598.48,"90th_percentile":3598.48,"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":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Pacemaker and Similar Procedures","code_information":[{"code":"5222","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"1 through 10","median_amount":16614.52,"10th_percentile":16614.52,"90th_percentile":16614.52,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 100% of Medicare]","count":"11","median_amount":8141.11,"10th_percentile":2619.01,"90th_percentile":8146.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"1 through 10","median_amount":13029.6,"10th_percentile":13029.6,"90th_percentile":13029.6},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":6492.3,"10th_percentile":6492.3,"90th_percentile":6492.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":32794.39,"10th_percentile":32794.39,"90th_percentile":32794.39},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"1 through 10","median_amount":18691.34,"10th_percentile":18691.34,"90th_percentile":18691.34,"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":"Blue Cross","plan_name":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"1 through 10","median_amount":15137.6,"10th_percentile":15137.6,"90th_percentile":15137.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":13012.6,"10th_percentile":12550.6,"90th_percentile":13012.6,"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":"Blue Cross","plan_name":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month 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 ($): 100% of Medicare]","count":"1 through 10","median_amount":8174.34,"10th_percentile":7695.56,"90th_percentile":8193.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"1 through 10","median_amount":13603.6,"10th_percentile":13603.6,"90th_percentile":14127.6,"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":"Blue Cross","plan_name":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"1 through 10","median_amount":9599.11,"10th_percentile":9599.11,"90th_percentile":9599.11},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":8156.56,"10th_percentile":8156.56,"90th_percentile":8156.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":8229.31,"10th_percentile":8229.31,"90th_percentile":8229.31,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":53815.42,"10th_percentile":53815.42,"90th_percentile":53815.42},{"payer_name":"Molina","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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":21791.0,"10th_percentile":21716.0,"90th_percentile":31943.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"14","median_amount":8229.93,"10th_percentile":8222.53,"90th_percentile":8390.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"11","median_amount":8229.52,"10th_percentile":7746.52,"90th_percentile":8233.41,"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."}]}]},{"description":"Level 3 Pacemaker and Similar Procedures","code_information":[{"code":"5223","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"19","median_amount":10300.29,"10th_percentile":9638.27,"90th_percentile":10325.59,"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":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"1 through 10","median_amount":15274.96,"10th_percentile":14200.97,"90th_percentile":32302.2,"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":"Blue Cross","plan_name":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":15017.0,"10th_percentile":15017.0,"90th_percentile":15017.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":11774.8,"10th_percentile":11774.8,"90th_percentile":11774.8,"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":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":10336.81,"10th_percentile":9676.46,"90th_percentile":10336.81,"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":"Blue Cross","plan_name":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"1 through 10","median_amount":15648.2,"10th_percentile":14901.8,"90th_percentile":22506.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"1 through 10","median_amount":19319.52,"10th_percentile":19319.52,"90th_percentile":19319.52},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":10440.15,"10th_percentile":10402.24,"90th_percentile":18955.99,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":5079.14,"10th_percentile":5079.14,"90th_percentile":5079.14,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"20","median_amount":10401.65,"10th_percentile":10397.75,"90th_percentile":10609.94,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":10401.64,"10th_percentile":9735.21,"90th_percentile":10405.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 4 Pacemaker and Similar Procedures","code_information":[{"code":"5224","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 100% of Medicare]","count":"1 through 10","median_amount":18765.88,"10th_percentile":18760.38,"90th_percentile":18785.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":21055.6,"10th_percentile":21055.6,"90th_percentile":21055.6,"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":"Blue Cross","plan_name":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month 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 ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"1 through 10","median_amount":26309.61,"10th_percentile":26309.61,"90th_percentile":26309.61},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"1 through 10","median_amount":24835.19,"10th_percentile":24835.19,"90th_percentile":24835.19},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":18957.78,"10th_percentile":18950.49,"90th_percentile":19025.33,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":18947.99,"10th_percentile":18947.99,"90th_percentile":18955.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":18951.89,"10th_percentile":18951.89,"90th_percentile":18951.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 1 ICD and Similar Procedures","code_information":[{"code":"5231","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":30316.0,"10th_percentile":30316.0,"90th_percentile":30316.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":22305.72,"10th_percentile":22305.72,"90th_percentile":22392.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":22308.23,"10th_percentile":22308.23,"90th_percentile":22308.23,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":22301.22,"10th_percentile":22301.22,"90th_percentile":22301.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 2 ICD and Similar Procedures","code_information":[{"code":"5232","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"1 through 10","median_amount":64381.26,"10th_percentile":64381.26,"90th_percentile":64381.26,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 100% of Medicare]","count":"1 through 10","median_amount":31544.61,"10th_percentile":31542.61,"90th_percentile":31568.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":30710.71,"10th_percentile":30710.71,"90th_percentile":30710.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":36574.43,"10th_percentile":36574.43,"90th_percentile":36574.43},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"1 through 10","median_amount":72411.23,"10th_percentile":72411.23,"90th_percentile":72415.73,"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":"Blue Cross","plan_name":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"1 through 10","median_amount":32196.8,"10th_percentile":32196.8,"90th_percentile":32196.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":28942.26,"10th_percentile":28535.8,"90th_percentile":29609.8,"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":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month 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 ($): 100% of Medicare]","count":"1 through 10","median_amount":31691.06,"10th_percentile":31691.06,"90th_percentile":31691.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"1 through 10","median_amount":30479.0,"10th_percentile":30479.0,"90th_percentile":30479.0,"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":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"1 through 10","median_amount":49733.79,"10th_percentile":49733.79,"90th_percentile":70296.18},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"1 through 10","median_amount":36563.02,"10th_percentile":36563.02,"90th_percentile":36563.02},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":31543.01,"10th_percentile":31543.01,"90th_percentile":31543.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"17","median_amount":31859.01,"10th_percentile":29982.22,"90th_percentile":31862.9,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":59380.0,"10th_percentile":41565.74,"90th_percentile":97647.1,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"1 through 10","median_amount":3548.98,"10th_percentile":3548.98,"90th_percentile":3548.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"14","median_amount":31861.51,"10th_percentile":31854.51,"90th_percentile":32504.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":31861.51,"10th_percentile":31858.01,"90th_percentile":31877.06,"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."}]}]},{"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"15","median_amount":1389.26,"10th_percentile":1241.66,"90th_percentile":2028.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"1 through 10","median_amount":379.36,"10th_percentile":379.36,"90th_percentile":379.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"81","median_amount":861.05,"10th_percentile":609.21,"90th_percentile":1907.87,"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":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"1 through 10","median_amount":2115.6,"10th_percentile":2070.6,"90th_percentile":3540.22},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":1824.6,"10th_percentile":1824.6,"90th_percentile":1824.6,"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":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"17","median_amount":2330.73,"10th_percentile":1929.95,"90th_percentile":14575.24},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"1 through 10","median_amount":1991.5,"10th_percentile":1687.93,"90th_percentile":2785.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"38","median_amount":2543.0,"10th_percentile":2202.44,"90th_percentile":2738.0,"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":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"85","median_amount":2119.0,"10th_percentile":353.0,"90th_percentile":2119.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"16","median_amount":2402.0,"10th_percentile":610.9,"90th_percentile":2402.0,"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":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"50","median_amount":2378.67,"10th_percentile":738.19,"90th_percentile":6868.93,"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":"Blue Cross","plan_name":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"41","median_amount":2402.0,"10th_percentile":2372.87,"90th_percentile":2543.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"1 through 10","median_amount":3501.63,"10th_percentile":2325.97,"90th_percentile":5239.66},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"1 through 10","median_amount":1289.89,"10th_percentile":1289.89,"90th_percentile":1289.89},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":942.44,"10th_percentile":942.44,"90th_percentile":1470.36,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"62","median_amount":925.93,"10th_percentile":699.47,"90th_percentile":2105.52,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","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":278.86,"10th_percentile":278.86,"90th_percentile":366.3,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"17","median_amount":525.63,"10th_percentile":481.63,"90th_percentile":2137.18,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"11","median_amount":481.63,"10th_percentile":478.98,"90th_percentile":481.63,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"28","median_amount":1758.27,"10th_percentile":1523.92,"90th_percentile":14465.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"95","median_amount":1091.06,"10th_percentile":742.55,"90th_percentile":2456.6,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"1 through 10","median_amount":2095.02,"10th_percentile":787.69,"90th_percentile":4421.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"45","median_amount":1022.48,"10th_percentile":742.54,"90th_percentile":1995.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 1 Upper GI Procedures","code_information":[{"code":"5301","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"27","median_amount":1890.06,"10th_percentile":1882.2,"90th_percentile":5609.51,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 100% of Medicare]","count":"171","median_amount":927.78,"10th_percentile":922.28,"90th_percentile":1831.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"32","median_amount":7281.0,"10th_percentile":1882.2,"90th_percentile":10288.2},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"34","median_amount":4002.6,"10th_percentile":3501.3,"90th_percentile":5785.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"21","median_amount":7462.66,"10th_percentile":6459.77,"90th_percentile":10431.22},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"78","median_amount":2117.48,"10th_percentile":2117.48,"90th_percentile":3176.22,"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":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. 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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":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":2816.0,"10th_percentile":2816.0,"90th_percentile":3393.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month 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 ($): 100% of Medicare]","count":"40","median_amount":929.91,"10th_percentile":821.11,"90th_percentile":3495.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"68","median_amount":3195.0,"10th_percentile":2556.03,"90th_percentile":3383.0,"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":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"39","median_amount":8726.28,"10th_percentile":1598.73,"90th_percentile":12478.43},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"1 through 10","median_amount":4805.25,"10th_percentile":4446.12,"90th_percentile":16715.61},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"1 through 10","median_amount":4689.88,"10th_percentile":4689.88,"90th_percentile":4689.88,"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":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":1194.66,"10th_percentile":1194.66,"90th_percentile":1194.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"100","median_amount":943.62,"10th_percentile":935.4,"90th_percentile":2166.04,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":7738.98,"10th_percentile":7269.09,"90th_percentile":32222.46},{"payer_name":"Molina","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":644.88,"10th_percentile":644.88,"90th_percentile":644.88,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":676.5,"10th_percentile":4.1,"90th_percentile":1067.03,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"27","median_amount":644.88,"10th_percentile":230.3,"90th_percentile":648.98,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"52","median_amount":2738.0,"10th_percentile":2511.0,"90th_percentile":4107.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"19","median_amount":3353.28,"10th_percentile":2606.16,"90th_percentile":5264.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"186","median_amount":1057.73,"10th_percentile":833.75,"90th_percentile":2594.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 104% of Medicare]","count":"1 through 10","median_amount":959.17,"10th_percentile":959.17,"90th_percentile":959.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"74","median_amount":1148.64,"10th_percentile":935.4,"90th_percentile":1658.7,"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 2 Upper GI Procedures","code_information":[{"code":"5302","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"1 through 10","median_amount":3808.32,"10th_percentile":3808.32,"90th_percentile":3816.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"101","median_amount":1869.93,"10th_percentile":1720.46,"90th_percentile":1871.88,"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":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"16","median_amount":8233.8,"10th_percentile":6015.71,"90th_percentile":10533.9},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"21","median_amount":4575.0,"10th_percentile":3864.9,"90th_percentile":6009.0,"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":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"12","median_amount":8655.38,"10th_percentile":8355.94,"90th_percentile":10944.33},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"32","median_amount":4284.36,"10th_percentile":3941.19,"90th_percentile":4302.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"35","median_amount":5597.0,"10th_percentile":4409.43,"90th_percentile":6777.0,"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":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"40","median_amount":4935.0,"10th_percentile":4935.0,"90th_percentile":5225.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":4935.0,"10th_percentile":4935.0,"90th_percentile":5225.0,"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":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"35","median_amount":1873.69,"10th_percentile":1723.61,"90th_percentile":1877.56,"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":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"53","median_amount":5597.0,"10th_percentile":4477.66,"90th_percentile":6008.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"15","median_amount":10488.11,"10th_percentile":7728.07,"90th_percentile":22053.23},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"1 through 10","median_amount":5702.96,"10th_percentile":4745.25,"90th_percentile":6290.78},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"1 through 10","median_amount":6434.16,"10th_percentile":6434.16,"90th_percentile":6434.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":1873.83,"10th_percentile":1873.83,"90th_percentile":1873.83,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"70","median_amount":1889.24,"10th_percentile":1740.28,"90th_percentile":1894.53,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":10319.46,"10th_percentile":10319.46,"90th_percentile":10319.46},{"payer_name":"Molina","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":1500.0,"10th_percentile":1500.0,"90th_percentile":1500.0,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":1032.9,"10th_percentile":1032.9,"90th_percentile":1032.9,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":648.98,"10th_percentile":648.98,"90th_percentile":965.29,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"21","median_amount":4107.0,"10th_percentile":2115.6,"90th_percentile":4414.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"1 through 10","median_amount":3893.35,"10th_percentile":2803.92,"90th_percentile":9547.44,"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":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"95","median_amount":1891.74,"10th_percentile":1739.38,"90th_percentile":1927.17,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"1 through 10","median_amount":1944.72,"10th_percentile":1792.56,"90th_percentile":1944.72,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"52","median_amount":1888.64,"10th_percentile":1737.68,"90th_percentile":1895.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 3 Upper GI Procedures","code_information":[{"code":"5303","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 100% of Medicare]","count":"1 through 10","median_amount":3748.03,"10th_percentile":3748.03,"90th_percentile":3748.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"1 through 10","median_amount":14140.35,"10th_percentile":14140.35,"90th_percentile":14140.35},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":7187.25,"10th_percentile":7187.25,"90th_percentile":7187.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"1 through 10","median_amount":8592.55,"10th_percentile":8592.55,"90th_percentile":8592.55,"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":"Blue Cross","plan_name":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"1 through 10","median_amount":10993.0,"10th_percentile":10993.0,"90th_percentile":10993.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month 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 ($): 100% of Medicare]","count":"1 through 10","median_amount":3757.81,"10th_percentile":3757.81,"90th_percentile":3757.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":3784.46,"10th_percentile":3784.46,"90th_percentile":3784.46,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"1 through 10","median_amount":14200.0,"10th_percentile":14200.0,"90th_percentile":14200.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":6855.38,"10th_percentile":6855.38,"90th_percentile":6855.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% 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":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"16","median_amount":1830.32,"10th_percentile":1830.32,"90th_percentile":1830.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"50","median_amount":896.86,"10th_percentile":824.51,"90th_percentile":896.86,"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":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"46","median_amount":6793.8,"10th_percentile":1830.32,"90th_percentile":7200.6},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"71","median_amount":3396.9,"10th_percentile":3396.9,"90th_percentile":4177.5,"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":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"46","median_amount":6357.3,"10th_percentile":5722.77,"90th_percentile":7818.19},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"56","median_amount":2059.11,"10th_percentile":2059.11,"90th_percentile":2067.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"64","median_amount":3658.0,"10th_percentile":3195.0,"90th_percentile":3832.0,"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":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"64","median_amount":2816.0,"10th_percentile":2816.0,"90th_percentile":2982.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"14","median_amount":2816.0,"10th_percentile":2816.0,"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":"Blue Cross","plan_name":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"16","median_amount":900.52,"10th_percentile":827.88,"90th_percentile":2165.82,"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":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"83","median_amount":3195.0,"10th_percentile":2816.0,"90th_percentile":3383.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"49","median_amount":7631.7,"10th_percentile":3953.04,"90th_percentile":8459.38},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"1 through 10","median_amount":3953.04,"10th_percentile":3929.1,"90th_percentile":7631.7},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":900.76,"10th_percentile":896.86,"90th_percentile":900.76,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"35","median_amount":905.82,"10th_percentile":905.82,"90th_percentile":909.71,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":7208.46,"10th_percentile":6357.3,"90th_percentile":13759.0},{"payer_name":"Molina","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":1064.41,"10th_percentile":1064.41,"90th_percentile":1064.41,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":640.83,"10th_percentile":640.83,"90th_percentile":640.83,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":640.83,"10th_percentile":636.88,"90th_percentile":1072.33,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"72","median_amount":2738.0,"10th_percentile":1986.0,"90th_percentile":2943.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"1 through 10","median_amount":2717.52,"10th_percentile":2717.52,"90th_percentile":3012.24,"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":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"43","median_amount":905.83,"10th_percentile":836.66,"90th_percentile":1251.34,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"1 through 10","median_amount":1285.73,"10th_percentile":1285.73,"90th_percentile":1285.73,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"40","median_amount":905.82,"10th_percentile":832.75,"90th_percentile":1249.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 2 Lower GI Procedures","code_information":[{"code":"5312","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"43","median_amount":3308.18,"10th_percentile":2367.08,"90th_percentile":4249.28,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 100% of Medicare]","count":"278","median_amount":1739.8,"10th_percentile":1159.87,"90th_percentile":2200.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"120","median_amount":7768.2,"10th_percentile":3258.94,"90th_percentile":10345.2},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"137","median_amount":4132.8,"10th_percentile":3640.5,"90th_percentile":5792.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"79","median_amount":7307.82,"10th_percentile":6491.88,"90th_percentile":10560.97},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"169","median_amount":2662.97,"10th_percentile":2662.97,"90th_percentile":3721.71,"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":"Blue Cross","plan_name":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"189","median_amount":4571.0,"10th_percentile":3201.63,"90th_percentile":4843.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"167","median_amount":3525.0,"10th_percentile":3525.0,"90th_percentile":3900.0,"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":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"37","median_amount":3525.0,"10th_percentile":3525.0,"90th_percentile":3732.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month 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 ($): 100% of Medicare]","count":"73","median_amount":1603.4,"10th_percentile":1164.6,"90th_percentile":2209.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"226","median_amount":4002.0,"10th_percentile":67.0,"90th_percentile":4571.0,"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":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"1 through 10","median_amount":3525.0,"10th_percentile":3525.0,"90th_percentile":4571.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"110","median_amount":8726.28,"10th_percentile":4524.56,"90th_percentile":11749.18},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"32","median_amount":5035.34,"10th_percentile":4440.22,"90th_percentile":6793.58},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"1 through 10","median_amount":6302.85,"10th_percentile":6302.85,"90th_percentile":6302.85,"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":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":1739.8,"10th_percentile":1624.91,"90th_percentile":1747.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"164","median_amount":1171.47,"10th_percentile":1075.23,"90th_percentile":1757.21,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":8222.44,"10th_percentile":6861.48,"90th_percentile":11674.67},{"payer_name":"Molina","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":640.83,"10th_percentile":640.83,"90th_percentile":961.24,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":10858.19,"10th_percentile":10858.19,"90th_percentile":10858.19},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":1000.86,"10th_percentile":739.88,"90th_percentile":1115.26,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"26","median_amount":640.83,"10th_percentile":636.88,"90th_percentile":805.39,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"176","median_amount":4107.0,"10th_percentile":2738.0,"90th_percentile":4414.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"46","median_amount":3125.28,"10th_percentile":129.95,"90th_percentile":4360.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":2738.0,"10th_percentile":2738.0,"90th_percentile":2738.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"189","median_amount":1670.64,"10th_percentile":1171.48,"90th_percentile":2268.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 104% of Medicare]","count":"1 through 10","median_amount":1663.25,"10th_percentile":1206.26,"90th_percentile":2171.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"178","median_amount":1757.2,"10th_percentile":1171.47,"90th_percentile":2222.95,"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 3 Lower GI Procedures","code_information":[{"code":"5313","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"1 through 10","median_amount":5874.98,"10th_percentile":5874.98,"90th_percentile":5889.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":2703.7,"10th_percentile":2703.5,"90th_percentile":2882.91,"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":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"1 through 10","median_amount":11363.89,"10th_percentile":4705.2,"90th_percentile":16302.6},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":11596.81,"10th_percentile":11596.81,"90th_percentile":11596.81,"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":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":18207.0,"10th_percentile":18207.0,"90th_percentile":18207.0},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"1 through 10","median_amount":6618.94,"10th_percentile":6618.94,"90th_percentile":6640.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"1 through 10","median_amount":7309.02,"10th_percentile":7309.02,"90th_percentile":8131.6,"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":"Blue Cross","plan_name":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":5635.0,"10th_percentile":5635.0,"90th_percentile":5635.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":5635.0,"10th_percentile":5635.0,"90th_percentile":5635.0,"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":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":2890.49,"10th_percentile":2890.49,"90th_percentile":2890.49,"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":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"1 through 10","median_amount":6393.0,"10th_percentile":6393.0,"90th_percentile":6393.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"1 through 10","median_amount":16520.48,"10th_percentile":16520.48,"90th_percentile":16520.48},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"1 through 10","median_amount":11475.54,"10th_percentile":11475.54,"90th_percentile":11475.54},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":3125.77,"10th_percentile":3125.77,"90th_percentile":3125.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":9799.56,"10th_percentile":9799.56,"90th_percentile":9799.56},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":5452.4,"10th_percentile":4414.5,"90th_percentile":7807.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":2724.69,"10th_percentile":2724.69,"90th_percentile":2867.5,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":2724.68,"10th_percentile":2558.35,"90th_percentile":2724.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Complex GI Procedures","code_information":[{"code":"5331","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 100% of Medicare]","count":"1 through 10","median_amount":5861.6,"10th_percentile":5861.6,"90th_percentile":5862.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":17828.28,"10th_percentile":17828.28,"90th_percentile":17828.28},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month 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 ($): 100% of Medicare]","count":"1 through 10","median_amount":5879.71,"10th_percentile":5879.71,"90th_percentile":5879.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"1 through 10","median_amount":9139.0,"10th_percentile":9139.0,"90th_percentile":9139.0,"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":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":5198.61,"10th_percentile":5198.61,"90th_percentile":5198.61,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":6035.06,"10th_percentile":6035.06,"90th_percentile":6035.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Abdominal/Peritoneal/Biliary and Related Procedures","code_information":[{"code":"5341","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"1 through 10","median_amount":6677.18,"10th_percentile":6677.18,"90th_percentile":6677.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"12","median_amount":3485.72,"10th_percentile":3471.55,"90th_percentile":3635.52,"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":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"1 through 10","median_amount":14867.1,"10th_percentile":7084.8,"90th_percentile":18567.14},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":16881.08,"10th_percentile":16881.08,"90th_percentile":21175.84},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"1 through 10","median_amount":7970.4,"10th_percentile":7970.4,"90th_percentile":8333.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"1 through 10","median_amount":10064.67,"10th_percentile":8878.34,"90th_percentile":13216.0,"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":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":7858.0,"10th_percentile":7858.0,"90th_percentile":8320.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":3672.04,"10th_percentile":3672.04,"90th_percentile":3672.04,"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":"Blue Cross","plan_name":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"14","median_amount":8911.0,"10th_percentile":8019.9,"90th_percentile":10999.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"1 through 10","median_amount":21400.51,"10th_percentile":19374.47,"90th_percentile":24988.98},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"16","median_amount":3670.51,"10th_percentile":3158.01,"90th_percentile":6229.01,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":2551.34,"10th_percentile":2551.34,"90th_percentile":2551.34,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":9358.0,"10th_percentile":8705.0,"90th_percentile":9358.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"1 through 10","median_amount":7604.86,"10th_percentile":7604.86,"90th_percentile":7604.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"14","median_amount":3666.4,"10th_percentile":3165.05,"90th_percentile":3888.21,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":3310.14,"10th_percentile":3155.01,"90th_percentile":3669.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 2 Abdominal/Peritoneal/Biliary and Related Procedures","code_information":[{"code":"5342","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"1 through 10","median_amount":12528.78,"10th_percentile":12528.78,"90th_percentile":12528.78,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 100% of Medicare]","count":"1 through 10","median_amount":6338.17,"10th_percentile":6333.39,"90th_percentile":6347.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"1 through 10","median_amount":12526.68,"10th_percentile":2398.8,"90th_percentile":16062.25},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":20663.04,"10th_percentile":19650.07,"90th_percentile":20792.47},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"1 through 10","median_amount":14516.65,"10th_percentile":14516.65,"90th_percentile":14516.65,"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":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"1 through 10","median_amount":9992.36,"10th_percentile":9992.36,"90th_percentile":9992.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":7858.0,"10th_percentile":1500.0,"90th_percentile":7858.0,"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":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month 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 ($): 100% of Medicare]","count":"1 through 10","median_amount":6348.71,"10th_percentile":6348.71,"90th_percentile":6348.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"1 through 10","median_amount":8911.0,"10th_percentile":8911.0,"90th_percentile":15839.2,"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":"Blue Cross","plan_name":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"1 through 10","median_amount":26341.93,"10th_percentile":26341.93,"90th_percentile":26341.93},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":7703.37,"10th_percentile":7703.37,"90th_percentile":7703.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":6391.93,"10th_percentile":233.61,"90th_percentile":6577.1,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":15296.2,"10th_percentile":15296.2,"90th_percentile":15296.2},{"payer_name":"Molina","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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":9358.0,"10th_percentile":9358.0,"90th_percentile":9358.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":6395.1,"10th_percentile":6395.1,"90th_percentile":6395.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":6396.87,"10th_percentile":6390.41,"90th_percentile":6403.9,"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 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":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"55","median_amount":11712.82,"10th_percentile":10623.1,"90th_percentile":12125.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"1 through 10","median_amount":3025.7,"10th_percentile":3025.7,"90th_percentile":3140.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"72","median_amount":5749.39,"10th_percentile":5205.32,"90th_percentile":7364.77,"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":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"35","median_amount":10623.1,"10th_percentile":1303.57,"90th_percentile":22042.75},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"20","median_amount":12560.68,"10th_percentile":9039.45,"90th_percentile":22025.55,"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":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"43","median_amount":20693.15,"10th_percentile":15112.47,"90th_percentile":34882.29},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"94","median_amount":13178.97,"10th_percentile":13176.92,"90th_percentile":14060.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"81","median_amount":9265.46,"10th_percentile":6968.99,"90th_percentile":10994.0,"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":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"72","median_amount":7858.0,"10th_percentile":7858.0,"90th_percentile":7858.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"11","median_amount":7858.0,"10th_percentile":7858.0,"90th_percentile":8320.0,"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":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"1 through 10","median_amount":10445.0,"10th_percentile":10445.0,"90th_percentile":10445.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"28","median_amount":5947.55,"10th_percentile":5226.57,"90th_percentile":7467.19,"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":"Blue Cross","plan_name":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"115","median_amount":8911.0,"10th_percentile":7128.82,"90th_percentile":9460.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"53","median_amount":23348.31,"10th_percentile":1015.56,"90th_percentile":32760.79},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"1 through 10","median_amount":15767.51,"10th_percentile":1525.26,"90th_percentile":30780.97},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"1 through 10","median_amount":19706.62,"10th_percentile":16483.53,"90th_percentile":35157.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"58","median_amount":5804.06,"10th_percentile":299.3,"90th_percentile":6048.39,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"15","median_amount":21731.77,"10th_percentile":19438.81,"90th_percentile":38627.09},{"payer_name":"Molina","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":2901.83,"10th_percentile":2333.94,"90th_percentile":4204.39,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":3149.69,"10th_percentile":2587.82,"90th_percentile":24037.5,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"39","median_amount":2663.07,"10th_percentile":2333.94,"90th_percentile":3031.66,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"73","median_amount":15383.0,"10th_percentile":7232.48,"90th_percentile":21913.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"30","median_amount":8951.68,"10th_percentile":6502.79,"90th_percentile":13423.85,"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":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":15383.0,"10th_percentile":15383.0,"90th_percentile":15383.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"66","median_amount":5914.97,"10th_percentile":5262.98,"90th_percentile":6181.21,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"1 through 10","median_amount":6201.44,"10th_percentile":6201.44,"90th_percentile":6215.31,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"44","median_amount":5803.67,"10th_percentile":381.58,"90th_percentile":5994.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 2 Laparoscopy and Related Services","code_information":[{"code":"5362","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"22","median_amount":20901.14,"10th_percentile":1925.32,"90th_percentile":21293.02,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 100% of Medicare]","count":"33","median_amount":10247.36,"10th_percentile":9291.35,"90th_percentile":10432.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"18","median_amount":16716.04,"10th_percentile":591.0,"90th_percentile":30449.16},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":13970.25,"10th_percentile":11729.85,"90th_percentile":21135.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"23","median_amount":31585.37,"10th_percentile":19353.59,"90th_percentile":36209.47},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"24","median_amount":23941.26,"10th_percentile":23513.78,"90th_percentile":23964.45,"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":"Blue Cross","plan_name":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"28","median_amount":10445.0,"10th_percentile":8356.13,"90th_percentile":13497.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"39","median_amount":7858.0,"10th_percentile":7562.7,"90th_percentile":10940.2,"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":"Blue Cross","plan_name":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":7858.0,"10th_percentile":7675.48,"90th_percentile":10232.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month 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 ($): 100% of Medicare]","count":"1 through 10","median_amount":10653.05,"10th_percentile":10653.05,"90th_percentile":10653.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"47","median_amount":10734.0,"10th_percentile":7128.89,"90th_percentile":11993.2,"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":"Blue Cross","plan_name":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"16","median_amount":33986.85,"10th_percentile":1701.57,"90th_percentile":45641.51},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"1 through 10","median_amount":18638.69,"10th_percentile":17905.81,"90th_percentile":24190.44},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":9294.1,"10th_percentile":9294.1,"90th_percentile":9294.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"28","median_amount":10534.83,"10th_percentile":299.3,"90th_percentile":10738.91,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":32165.8,"10th_percentile":32165.8,"90th_percentile":52687.0},{"payer_name":"Molina","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":3756.73,"10th_percentile":3756.73,"90th_percentile":3756.73,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":5158.19,"10th_percentile":5158.19,"90th_percentile":5158.19,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"29","median_amount":17085.74,"10th_percentile":15383.0,"90th_percentile":34339.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"15","median_amount":13720.0,"10th_percentile":6860.0,"90th_percentile":13993.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"29","median_amount":10547.13,"10th_percentile":2149.1,"90th_percentile":10752.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"21","median_amount":10350.98,"10th_percentile":354.3,"90th_percentile":10547.52,"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."}]}]},{"description":"Level 1 Urology and Related Services","code_information":[{"code":"5371","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":397.53,"10th_percentile":397.53,"90th_percentile":397.53,"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":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"1 through 10","median_amount":1693.0,"10th_percentile":1693.0,"90th_percentile":1693.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":401.48,"10th_percentile":401.48,"90th_percentile":401.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":246.57,"10th_percentile":246.57,"90th_percentile":246.57,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"1 through 10","median_amount":249.84,"10th_percentile":249.84,"90th_percentile":249.84,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Urology and Related Services","code_information":[{"code":"5372","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":1188.83,"10th_percentile":1188.83,"90th_percentile":1188.83},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month 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 ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"1 through 10","median_amount":705.1,"10th_percentile":705.1,"90th_percentile":705.1},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":330.9,"10th_percentile":330.9,"90th_percentile":330.9,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":855.1,"10th_percentile":855.1,"90th_percentile":855.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Urology and Related Services","code_information":[{"code":"5373","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"1 through 10","median_amount":3749.98,"10th_percentile":3749.98,"90th_percentile":3749.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"18","median_amount":2020.62,"10th_percentile":2015.12,"90th_percentile":2024.48,"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":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"1 through 10","median_amount":19436.4,"10th_percentile":19436.4,"90th_percentile":19436.4},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":9834.42,"10th_percentile":9834.42,"90th_percentile":9834.42,"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":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":14440.13,"10th_percentile":128.6,"90th_percentile":18551.56},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"1 through 10","median_amount":4626.56,"10th_percentile":4626.56,"90th_percentile":4626.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. 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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":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":4935.0,"10th_percentile":4935.0,"90th_percentile":4935.0,"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":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":2023.35,"10th_percentile":1844.99,"90th_percentile":2123.22,"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":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"13","median_amount":5597.0,"10th_percentile":4397.64,"90th_percentile":5597.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"1 through 10","median_amount":13494.16,"10th_percentile":8066.76,"90th_percentile":20078.81},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"1 through 10","median_amount":9318.37,"10th_percentile":9318.37,"90th_percentile":9318.37},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"19","median_amount":2041.17,"10th_percentile":2035.27,"90th_percentile":2058.43,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":1009.03,"10th_percentile":1009.03,"90th_percentile":1009.03,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":1309.59,"10th_percentile":1309.59,"90th_percentile":1309.59,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":2943.0,"10th_percentile":2738.0,"90th_percentile":7807.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"20","median_amount":2040.28,"10th_percentile":1893.74,"90th_percentile":2135.73,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"1 through 10","median_amount":2104.28,"10th_percentile":2104.28,"90th_percentile":2104.28,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":2039.17,"10th_percentile":2038.77,"90th_percentile":2042.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 4 Urology and Related Services","code_information":[{"code":"5374","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"1 through 10","median_amount":13656.9,"10th_percentile":13656.9,"90th_percentile":13656.9,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 100% of Medicare]","count":"25","median_amount":3398.27,"10th_percentile":3392.77,"90th_percentile":3424.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"1 through 10","median_amount":7222.8,"10th_percentile":579.6,"90th_percentile":17913.9},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":7878.9,"10th_percentile":7878.9,"90th_percentile":7878.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":13261.75,"10th_percentile":13261.75,"90th_percentile":27755.84},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"15","median_amount":7790.31,"10th_percentile":7220.66,"90th_percentile":12029.87,"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":"Blue Cross","plan_name":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"1 through 10","median_amount":10445.0,"10th_percentile":7163.0,"90th_percentile":12342.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":7858.0,"10th_percentile":7858.0,"90th_percentile":11584.0,"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":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":7858.0,"10th_percentile":7858.0,"90th_percentile":7858.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month 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 ($): 100% of Medicare]","count":"1 through 10","median_amount":3406.62,"10th_percentile":3406.62,"90th_percentile":4921.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"11","median_amount":8911.0,"10th_percentile":6071.0,"90th_percentile":9435.0,"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":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"1 through 10","median_amount":22091.74,"10th_percentile":200.0,"90th_percentile":33334.14},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"1 through 10","median_amount":17199.57,"10th_percentile":17199.57,"90th_percentile":17199.57},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"32","median_amount":3432.6,"10th_percentile":3180.94,"90th_percentile":3440.68,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":1485.16,"10th_percentile":1021.83,"90th_percentile":1879.46,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"11","median_amount":7361.28,"10th_percentile":2597.0,"90th_percentile":10893.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"1 through 10","median_amount":5023.32,"10th_percentile":1708.32,"90th_percentile":14200.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"17","median_amount":3433.7,"10th_percentile":3246.57,"90th_percentile":4931.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":3185.44,"10th_percentile":3178.84,"90th_percentile":3434.44,"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."}]}]},{"description":"Level 5 Urology and Related Services","code_information":[{"code":"5375","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"11","median_amount":12339.88,"10th_percentile":9526.5,"90th_percentile":12866.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"34","median_amount":5006.58,"10th_percentile":4676.84,"90th_percentile":6291.89,"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":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"1 through 10","median_amount":13948.2,"10th_percentile":4313.4,"90th_percentile":16794.3},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":11319.0,"10th_percentile":8338.35,"90th_percentile":13965.9,"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":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":16968.0,"10th_percentile":16534.64,"90th_percentile":17372.96},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"11","median_amount":15723.11,"10th_percentile":10717.31,"90th_percentile":15764.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"14","median_amount":9893.7,"10th_percentile":8878.39,"90th_percentile":10915.03,"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":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":7858.0,"10th_percentile":7858.0,"90th_percentile":8216.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":8443.0,"10th_percentile":8443.0,"90th_percentile":8443.0,"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":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"20","median_amount":5028.93,"10th_percentile":135.0,"90th_percentile":6331.83,"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":"Blue Cross","plan_name":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"15","median_amount":9269.2,"10th_percentile":8911.0,"90th_percentile":13161.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"1 through 10","median_amount":20232.8,"10th_percentile":547.29,"90th_percentile":28453.65},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"1 through 10","median_amount":10072.77,"10th_percentile":10072.77,"90th_percentile":15875.87},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":5004.68,"10th_percentile":5004.68,"90th_percentile":5004.68,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"40","median_amount":5056.69,"10th_percentile":4720.66,"90th_percentile":6357.97,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":22525.86,"10th_percentile":22525.86,"90th_percentile":22525.86},{"payer_name":"Molina","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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":2722.89,"10th_percentile":2689.74,"90th_percentile":2903.31,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":10002.0,"10th_percentile":5323.41,"90th_percentile":10752.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"1 through 10","median_amount":7901.53,"10th_percentile":5751.84,"90th_percentile":12757.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"21","median_amount":5057.8,"10th_percentile":4814.85,"90th_percentile":6348.98,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"1 through 10","median_amount":5205.81,"10th_percentile":5205.81,"90th_percentile":5205.81,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":5054.29,"10th_percentile":536.58,"90th_percentile":6374.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 6 Urology and Related Services","code_information":[{"code":"5376","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"1 through 10","median_amount":18564.2,"10th_percentile":18564.2,"90th_percentile":18603.5,"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":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 100% of Medicare]","count":"1 through 10","median_amount":9099.96,"10th_percentile":8413.85,"90th_percentile":9119.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"1 through 10","median_amount":18749.4,"10th_percentile":18749.4,"90th_percentile":18749.4},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"1 through 10","median_amount":20884.73,"10th_percentile":20884.73,"90th_percentile":20884.73,"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":"Blue Cross","plan_name":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"1 through 10","median_amount":1464.0,"10th_percentile":1464.0,"90th_percentile":10687.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":1196.0,"10th_percentile":1196.0,"90th_percentile":8669.2,"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":"Blue Cross","plan_name":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":1130.0,"10th_percentile":1130.0,"90th_percentile":1130.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month 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 ($): 100% of Medicare]","count":"1 through 10","median_amount":9133.59,"10th_percentile":9133.59,"90th_percentile":9133.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"1 through 10","median_amount":1355.0,"10th_percentile":1355.0,"90th_percentile":9793.2,"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":"Blue Cross","plan_name":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"1 through 10","median_amount":28681.87,"10th_percentile":28681.87,"90th_percentile":42769.01},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"1 through 10","median_amount":18267.0,"10th_percentile":18267.0,"90th_percentile":22953.28},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":9193.32,"10th_percentile":9193.32,"90th_percentile":9224.92,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":10752.0,"10th_percentile":10752.0,"90th_percentile":10752.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"1 through 10","median_amount":13720.0,"10th_percentile":13426.01,"90th_percentile":13795.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":9192.34,"10th_percentile":8396.88,"90th_percentile":9398.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":9194.42,"10th_percentile":9194.42,"90th_percentile":9194.42,"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."}]}]},{"description":"Level 8 Urology and Related Services","code_information":[{"code":"5378","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":12679.15,"10th_percentile":12679.15,"90th_percentile":12679.15,"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":"Blue Cross","plan_name":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":19881.38,"10th_percentile":19881.38,"90th_percentile":19881.38,"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":"Blue Cross","plan_name":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":18408.74,"10th_percentile":18408.74,"90th_percentile":18408.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":20414.64,"10th_percentile":20414.64,"90th_percentile":20414.64,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":20003.2,"10th_percentile":20003.2,"90th_percentile":20003.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Dialysis","code_information":[{"code":"5401","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"1 through 10","median_amount":2469.12,"10th_percentile":2469.12,"90th_percentile":2469.12,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"1 through 10","median_amount":2777.76,"10th_percentile":2777.76,"90th_percentile":2777.76,"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":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month 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 ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"1 through 10","median_amount":794.86,"10th_percentile":754.48,"90th_percentile":794.86,"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":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":3380.31,"10th_percentile":3380.31,"90th_percentile":4060.24,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":90.0,"10th_percentile":90.0,"90th_percentile":90.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":2038.63,"10th_percentile":2038.63,"90th_percentile":2038.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Gynecologic Procedures","code_information":[{"code":"5411","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"1 through 10","median_amount":2251.8,"10th_percentile":2251.8,"90th_percentile":2251.8},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":249.0,"10th_percentile":249.0,"90th_percentile":249.0,"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":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":1761.27,"10th_percentile":1443.48,"90th_percentile":2786.89},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"1 through 10","median_amount":454.34,"10th_percentile":454.34,"90th_percentile":454.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"1 through 10","median_amount":1660.0,"10th_percentile":1660.0,"90th_percentile":1922.0,"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":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":1696.0,"10th_percentile":1696.0,"90th_percentile":23803.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"1 through 10","median_amount":1406.4,"10th_percentile":630.0,"90th_percentile":2035.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"1 through 10","median_amount":1443.48,"10th_percentile":1443.48,"90th_percentile":1831.91},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"1 through 10","median_amount":1878.76,"10th_percentile":1878.76,"90th_percentile":1878.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","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":126.79,"10th_percentile":126.79,"90th_percentile":126.79,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":126.79,"10th_percentile":126.79,"90th_percentile":126.79,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"14","median_amount":126.79,"10th_percentile":7.27,"90th_percentile":134.06,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":1599.6,"10th_percentile":1599.6,"90th_percentile":1599.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Gynecologic Procedures","code_information":[{"code":"5412","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"1 through 10","median_amount":1166.56,"10th_percentile":1166.56,"90th_percentile":1166.56,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 100% of Medicare]","count":"1 through 10","median_amount":574.11,"10th_percentile":574.11,"90th_percentile":574.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"1 through 10","median_amount":1312.39,"10th_percentile":1312.39,"90th_percentile":1312.39,"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":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"1 through 10","median_amount":704.57,"10th_percentile":704.57,"90th_percentile":704.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":1696.0,"10th_percentile":1696.0,"90th_percentile":1696.0,"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":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month 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 ($): 100% of Medicare]","count":"1 through 10","median_amount":573.94,"10th_percentile":573.94,"90th_percentile":573.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","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":160.22,"10th_percentile":160.22,"90th_percentile":160.22,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":2597.0,"10th_percentile":2597.0,"90th_percentile":2597.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Gynecologic Procedures","code_information":[{"code":"5413","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"1 through 10","median_amount":3769.86,"10th_percentile":3769.86,"90th_percentile":3769.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":156.2,"10th_percentile":156.2,"90th_percentile":1869.89},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"1 through 10","median_amount":1966.57,"10th_percentile":1966.57,"90th_percentile":1966.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":379.52,"10th_percentile":379.52,"90th_percentile":379.52,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":539.74,"10th_percentile":539.74,"90th_percentile":539.74,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Gynecologic Procedures","code_information":[{"code":"5414","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"13","median_amount":6384.48,"10th_percentile":5755.94,"90th_percentile":6398.82,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 100% of Medicare]","count":"1 through 10","median_amount":3128.4,"10th_percentile":2831.92,"90th_percentile":3134.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"16","median_amount":12440.4,"10th_percentile":487.2,"90th_percentile":17361.6},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":7054.95,"10th_percentile":243.6,"90th_percentile":10816.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"11","median_amount":13678.97,"10th_percentile":13291.04,"90th_percentile":14933.15},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"21","median_amount":7182.54,"10th_percentile":7180.99,"90th_percentile":7184.37,"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":"Blue Cross","plan_name":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"16","median_amount":7988.0,"10th_percentile":7167.89,"90th_percentile":9138.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"24","median_amount":7044.0,"10th_percentile":7044.0,"90th_percentile":7458.0,"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":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":7044.0,"10th_percentile":7044.0,"90th_percentile":7458.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month 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 ($): 100% of Medicare]","count":"1 through 10","median_amount":3140.49,"10th_percentile":3140.49,"90th_percentile":3140.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"36","median_amount":7988.0,"10th_percentile":6390.47,"90th_percentile":8458.0,"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":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"16","median_amount":16473.91,"10th_percentile":10394.09,"90th_percentile":22296.26},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"1 through 10","median_amount":9050.68,"10th_percentile":9050.68,"90th_percentile":9469.34},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":3163.79,"10th_percentile":3163.79,"90th_percentile":3172.5,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","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":1239.38,"10th_percentile":1141.52,"90th_percentile":1521.98,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":1509.97,"10th_percentile":1509.97,"90th_percentile":1509.97,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"20","median_amount":1521.98,"10th_percentile":1152.56,"90th_percentile":1682.2,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"15","median_amount":7262.0,"10th_percentile":7262.0,"90th_percentile":7807.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"1 through 10","median_amount":6021.6,"10th_percentile":5490.0,"90th_percentile":7936.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":3223.47,"10th_percentile":3223.47,"90th_percentile":3223.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":3166.0,"10th_percentile":3166.0,"90th_percentile":3166.6,"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."}]}]},{"description":"Level 5 Gynecologic Procedures","code_information":[{"code":"5415","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"1 through 10","median_amount":9157.46,"10th_percentile":9157.46,"90th_percentile":9910.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":4863.91,"10th_percentile":4863.91,"90th_percentile":4863.91,"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":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"1 through 10","median_amount":15366.96,"10th_percentile":15366.96,"90th_percentile":15970.5},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":9024.6,"10th_percentile":7879.43,"90th_percentile":9788.1,"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":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":15917.84,"10th_percentile":15917.84,"90th_percentile":22104.35},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"1 through 10","median_amount":11166.68,"10th_percentile":11166.68,"90th_percentile":11166.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"1 through 10","median_amount":9400.5,"10th_percentile":8911.0,"90th_percentile":10445.0,"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":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":9344.2,"10th_percentile":7858.0,"90th_percentile":9844.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":4876.51,"10th_percentile":4876.51,"90th_percentile":4876.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"1 through 10","median_amount":8911.0,"10th_percentile":7219.26,"90th_percentile":10897.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"1 through 10","median_amount":18625.31,"10th_percentile":18625.31,"90th_percentile":18625.31},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"1 through 10","median_amount":11008.3,"10th_percentile":11008.3,"90th_percentile":11008.3},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":4910.47,"10th_percentile":4910.47,"90th_percentile":4912.57,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","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":2670.24,"10th_percentile":2670.24,"90th_percentile":2670.24,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":2711.1,"10th_percentile":2670.24,"90th_percentile":5149.22,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":9358.0,"10th_percentile":8705.0,"90th_percentile":13057.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":5005.36,"10th_percentile":5005.36,"90th_percentile":5005.36,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":4912.94,"10th_percentile":4912.94,"90th_percentile":4912.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 6 Gynecologic Procedures","code_information":[{"code":"5416","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"1 through 10","median_amount":20060.7,"10th_percentile":20060.7,"90th_percentile":20060.7},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":23191.17,"10th_percentile":23191.17,"90th_percentile":28741.69},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"1 through 10","median_amount":16710.21,"10th_percentile":16710.21,"90th_percentile":16710.21,"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":"Blue Cross","plan_name":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"1 through 10","median_amount":12586.4,"10th_percentile":12586.4,"90th_percentile":12586.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":2000.0,"10th_percentile":2000.0,"90th_percentile":2000.0,"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":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month 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 ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"1 through 10","median_amount":9738.0,"10th_percentile":9738.0,"90th_percentile":9738.0,"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":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":1654.4,"10th_percentile":1654.4,"90th_percentile":1654.4,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% 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":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"1 through 10","median_amount":3920.3,"10th_percentile":3920.3,"90th_percentile":3920.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":1926.45,"10th_percentile":1922.52,"90th_percentile":2028.71,"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":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"1 through 10","median_amount":16069.2,"10th_percentile":16069.2,"90th_percentile":16069.2},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":15009.38,"10th_percentile":15009.38,"90th_percentile":22685.27},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"1 through 10","median_amount":6012.44,"10th_percentile":5437.46,"90th_percentile":6777.0,"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":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":5225.0,"10th_percentile":5225.0,"90th_percentile":5225.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":1928.79,"10th_percentile":1928.79,"90th_percentile":1928.79,"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":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"1 through 10","median_amount":5926.0,"10th_percentile":5926.0,"90th_percentile":9435.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"1 through 10","median_amount":11098.85,"10th_percentile":11098.85,"90th_percentile":11098.85},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"1 through 10","median_amount":11928.56,"10th_percentile":11928.56,"90th_percentile":11928.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":1946.05,"10th_percentile":1946.05,"90th_percentile":1955.93,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":9906.57,"10th_percentile":9906.57,"90th_percentile":9906.57},{"payer_name":"Molina","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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":879.73,"10th_percentile":879.73,"90th_percentile":879.73,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":7807.0,"10th_percentile":7807.0,"90th_percentile":7807.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":1942.16,"10th_percentile":1940.77,"90th_percentile":1958.85,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":1947.15,"10th_percentile":1947.15,"90th_percentile":1947.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 2 Nerve Procedures","code_information":[{"code":"5432","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month 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 ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":6369.71,"10th_percentile":6369.71,"90th_percentile":6369.71,"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."}]}]},{"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"1 through 10","median_amount":592.62,"10th_percentile":592.62,"90th_percentile":592.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"15","median_amount":295.04,"10th_percentile":272.88,"90th_percentile":564.96,"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":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"1 through 10","median_amount":11781.9,"10th_percentile":11781.9,"90th_percentile":11781.9},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":1266.55,"10th_percentile":1266.55,"90th_percentile":1266.55},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"1 through 10","median_amount":1204.42,"10th_percentile":1204.42,"90th_percentile":1292.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"1 through 10","median_amount":1922.0,"10th_percentile":1922.0,"90th_percentile":1922.0,"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":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":1696.0,"10th_percentile":1696.0,"90th_percentile":1696.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":291.57,"10th_percentile":291.57,"90th_percentile":291.57,"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":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"1 through 10","median_amount":1922.0,"10th_percentile":1922.0,"90th_percentile":1922.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"1 through 10","median_amount":1508.55,"10th_percentile":1346.65,"90th_percentile":2427.07},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":294.28,"10th_percentile":294.28,"90th_percentile":294.28,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":299.27,"10th_percentile":297.78,"90th_percentile":383.02,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":172.62,"10th_percentile":172.62,"90th_percentile":172.62,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":362.67,"10th_percentile":362.67,"90th_percentile":362.67,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":2800.0,"10th_percentile":2800.0,"90th_percentile":2800.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":293.29,"10th_percentile":269.88,"90th_percentile":579.99,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":297.28,"10th_percentile":275.38,"90th_percentile":571.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 2 Nerve Injections","code_information":[{"code":"5442","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"1 through 10","median_amount":1390.28,"10th_percentile":1273.2,"90th_percentile":5603.76,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 100% of Medicare]","count":"36","median_amount":684.02,"10th_percentile":628.87,"90th_percentile":1537.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"1 through 10","median_amount":1357.2,"10th_percentile":1357.2,"90th_percentile":1357.2},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":840.18,"10th_percentile":741.6,"90th_percentile":1195.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":7958.47,"10th_percentile":7958.47,"90th_percentile":16432.55},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"1 through 10","median_amount":2525.79,"10th_percentile":2525.79,"90th_percentile":3873.19,"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":"Blue Cross","plan_name":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"1 through 10","median_amount":3054.41,"10th_percentile":2926.35,"90th_percentile":3195.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":2816.0,"10th_percentile":2816.0,"90th_percentile":2816.0,"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":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":2816.0,"10th_percentile":2816.0,"90th_percentile":2982.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month 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 ($): 100% of Medicare]","count":"1 through 10","median_amount":1380.17,"10th_percentile":626.41,"90th_percentile":3261.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"19","median_amount":3195.0,"10th_percentile":2370.0,"90th_percentile":3483.0,"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":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"1 through 10","median_amount":2816.0,"10th_percentile":2816.0,"90th_percentile":2816.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"1 through 10","median_amount":3001.99,"10th_percentile":1480.1,"90th_percentile":8699.33},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"1 through 10","median_amount":7397.48,"10th_percentile":7397.48,"90th_percentile":7397.48},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"14","median_amount":698.36,"10th_percentile":692.55,"90th_percentile":2109.94,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","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":384.32,"10th_percentile":384.32,"90th_percentile":384.32,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":1117.76,"10th_percentile":1117.76,"90th_percentile":1117.76,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":483.22,"10th_percentile":341.42,"90th_percentile":1042.31,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"13","median_amount":2027.0,"10th_percentile":1986.0,"90th_percentile":2135.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"1 through 10","median_amount":626.64,"10th_percentile":626.64,"90th_percentile":5955.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"13","median_amount":1112.62,"10th_percentile":690.05,"90th_percentile":2738.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":695.05,"10th_percentile":695.05,"90th_percentile":1248.94,"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."}]}]},{"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"1 through 10","median_amount":68391.0,"10th_percentile":68391.0,"90th_percentile":68391.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":881.29,"10th_percentile":881.29,"90th_percentile":881.29,"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":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"1 through 10","median_amount":3520.1,"10th_percentile":3520.1,"90th_percentile":3520.1},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":666.9,"10th_percentile":666.9,"90th_percentile":666.9,"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":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":4500.65,"10th_percentile":4500.65,"90th_percentile":4500.65},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"1 through 10","median_amount":3066.0,"10th_percentile":3066.0,"90th_percentile":3066.0,"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":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"1 through 10","median_amount":500.0,"10th_percentile":500.0,"90th_percentile":8731.89},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":903.7,"10th_percentile":903.7,"90th_percentile":903.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":1986.0,"10th_percentile":1986.0,"90th_percentile":16093.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":1183.32,"10th_percentile":1183.32,"90th_percentile":1892.89,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":1677.84,"10th_percentile":1677.84,"90th_percentile":1677.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 2 Neurostimulator and Related Procedures","code_information":[{"code":"5462","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month 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 ($): 100% of Medicare]","count":"1 through 10","median_amount":6490.05,"10th_percentile":6490.05,"90th_percentile":6490.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":4001.39,"10th_percentile":4001.39,"90th_percentile":4001.39,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Neurostimulator and Related Procedures","code_information":[{"code":"5464","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":21094.94,"10th_percentile":21094.94,"90th_percentile":21094.94,"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":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":25140.4,"10th_percentile":25140.4,"90th_percentile":25140.4,"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":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":21181.04,"10th_percentile":21181.04,"90th_percentile":21184.91,"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":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":21310.39,"10th_percentile":21310.39,"90th_percentile":21310.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":21305.89,"10th_percentile":21305.89,"90th_percentile":21305.89,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":21317.57,"10th_percentile":21317.57,"90th_percentile":21317.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 5 Neurostimulator and Related Procedures","code_information":[{"code":"5465","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 100% of Medicare]","count":"1 through 10","median_amount":28018.89,"10th_percentile":28018.89,"90th_percentile":28018.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"1 through 10","median_amount":68824.76,"10th_percentile":68824.76,"90th_percentile":68824.76,"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":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"1 through 10","median_amount":34758.2,"10th_percentile":34758.2,"90th_percentile":34758.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month 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 ($): 100% of Medicare]","count":"1 through 10","median_amount":30099.36,"10th_percentile":30099.36,"90th_percentile":30099.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":30382.58,"10th_percentile":30382.58,"90th_percentile":30382.58,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":36671.65,"10th_percentile":36671.65,"90th_percentile":36671.65},{"payer_name":"Molina","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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":7.94,"10th_percentile":7.94,"90th_percentile":7.94,"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."}]}]},{"description":"Level 1 Extraocular, Repair, and Plastic Eye Procedures","code_information":[{"code":"5501","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":98.48,"10th_percentile":98.48,"90th_percentile":98.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":426.14,"10th_percentile":426.14,"90th_percentile":426.14,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Imaging without Contrast","code_information":[{"code":"5521","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"1 through 10","median_amount":444.34,"10th_percentile":75.0,"90th_percentile":1672.2,"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":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":1318.35,"10th_percentile":1318.35,"90th_percentile":1318.35},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"1 through 10","median_amount":36.76,"10th_percentile":36.76,"90th_percentile":36.76,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"31","median_amount":78.55,"10th_percentile":77.95,"90th_percentile":79.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"35","median_amount":1071.6,"10th_percentile":159.08,"90th_percentile":1773.6},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":324.6,"10th_percentile":273.0,"90th_percentile":429.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":665.61,"10th_percentile":513.04,"90th_percentile":1411.36},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"1 through 10","median_amount":178.97,"10th_percentile":178.97,"90th_percentile":209.1,"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":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"72","median_amount":789.25,"10th_percentile":551.41,"90th_percentile":1003.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"13","median_amount":670.0,"10th_percentile":371.0,"90th_percentile":778.0,"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":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":834.0,"10th_percentile":371.0,"90th_percentile":1048.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"1 through 10","median_amount":823.0,"10th_percentile":823.0,"90th_percentile":823.0,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"17","median_amount":78.27,"10th_percentile":78.27,"90th_percentile":214.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"17","median_amount":762.0,"10th_percentile":582.0,"90th_percentile":882.0,"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":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"1 through 10","median_amount":658.4,"10th_percentile":658.4,"90th_percentile":658.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"44","median_amount":1153.22,"10th_percentile":754.88,"90th_percentile":1799.21},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"1 through 10","median_amount":754.88,"10th_percentile":754.88,"90th_percentile":1056.83},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"1 through 10","median_amount":76.97,"10th_percentile":76.97,"90th_percentile":76.97,"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":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"44","median_amount":80.34,"10th_percentile":74.82,"90th_percentile":91.98,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":1128.01,"10th_percentile":1128.01,"90th_percentile":1398.33},{"payer_name":"Molina","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":69.97,"10th_percentile":69.97,"90th_percentile":261.86,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"19","median_amount":62.59,"10th_percentile":35.59,"90th_percentile":69.97,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"31","median_amount":69.84,"10th_percentile":35.69,"90th_percentile":69.97,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"46","median_amount":359.0,"10th_percentile":161.13,"90th_percentile":844.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"1 through 10","median_amount":401.04,"10th_percentile":401.04,"90th_percentile":450.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":359.0,"10th_percentile":359.0,"90th_percentile":359.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"15","median_amount":79.04,"10th_percentile":75.12,"90th_percentile":168.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"1 through 10","median_amount":83.51,"10th_percentile":83.51,"90th_percentile":233.27,"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] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"14","median_amount":78.93,"10th_percentile":78.93,"90th_percentile":100.87,"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."}]}]},{"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"124","median_amount":213.48,"10th_percentile":202.42,"90th_percentile":213.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"104","median_amount":105.11,"10th_percentile":99.59,"90th_percentile":106.61,"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":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"163","median_amount":1128.0,"10th_percentile":202.42,"90th_percentile":1965.6},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"89","median_amount":847.5,"10th_percentile":492.9,"90th_percentile":1711.8,"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":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"141","median_amount":1536.19,"10th_percentile":922.46,"90th_percentile":2526.83},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"100","median_amount":240.17,"10th_percentile":240.17,"90th_percentile":309.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"290","median_amount":1040.0,"10th_percentile":832.3,"90th_percentile":1189.0,"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":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"401","median_amount":917.0,"10th_percentile":917.0,"90th_percentile":971.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"17","median_amount":917.0,"10th_percentile":656.0,"90th_percentile":971.0,"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":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"42","median_amount":105.03,"10th_percentile":99.59,"90th_percentile":105.03,"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":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"180","median_amount":1040.0,"10th_percentile":832.0,"90th_percentile":1189.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"1 through 10","median_amount":1040.0,"10th_percentile":917.0,"90th_percentile":1040.0,"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":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"118","median_amount":1703.87,"10th_percentile":872.7,"90th_percentile":2735.77},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"20","median_amount":980.27,"10th_percentile":601.7,"90th_percentile":1454.28},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"21","median_amount":104.0,"10th_percentile":74.2,"90th_percentile":364.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"76","median_amount":106.08,"10th_percentile":100.18,"90th_percentile":107.81,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":1419.35,"10th_percentile":1055.53,"90th_percentile":2825.0},{"payer_name":"Molina","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":"55","median_amount":96.24,"10th_percentile":69.97,"90th_percentile":160.4,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"175","median_amount":160.22,"10th_percentile":64.16,"90th_percentile":176.08,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"249","median_amount":96.24,"10th_percentile":64.16,"90th_percentile":161.29,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"161","median_amount":953.74,"10th_percentile":231.0,"90th_percentile":1536.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"34","median_amount":532.32,"10th_percentile":117.75,"90th_percentile":783.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"95","median_amount":107.81,"10th_percentile":102.22,"90th_percentile":107.81,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"1 through 10","median_amount":112.07,"10th_percentile":112.07,"90th_percentile":112.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"1 through 10","median_amount":109.39,"10th_percentile":109.39,"90th_percentile":109.39,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"39","median_amount":105.95,"10th_percentile":100.18,"90th_percentile":107.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 3 Imaging without Contrast","code_information":[{"code":"5523","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"88","median_amount":485.26,"10th_percentile":451.14,"90th_percentile":743.98,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":1682.4,"10th_percentile":1682.4,"90th_percentile":1682.4},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"1 through 10","median_amount":192.62,"10th_percentile":192.62,"90th_percentile":192.62,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"356","median_amount":239.28,"10th_percentile":221.46,"90th_percentile":531.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"119","median_amount":760.76,"10th_percentile":451.14,"90th_percentile":2449.2},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"60","median_amount":934.2,"10th_percentile":318.22,"90th_percentile":1406.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"80","median_amount":1753.68,"10th_percentile":529.38,"90th_percentile":2733.77},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"242","median_amount":545.92,"10th_percentile":136.48,"90th_percentile":1077.15,"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":"Blue Cross","plan_name":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"215","median_amount":1040.0,"10th_percentile":711.0,"90th_percentile":2324.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"256","median_amount":917.0,"10th_percentile":917.0,"90th_percentile":971.0,"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":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"28","median_amount":971.0,"10th_percentile":917.0,"90th_percentile":1796.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month 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 ($): 100% of Medicare]","count":"100","median_amount":238.75,"10th_percentile":221.96,"90th_percentile":543.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"132","median_amount":1040.0,"10th_percentile":840.0,"90th_percentile":1922.0,"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":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"1 through 10","median_amount":1040.0,"10th_percentile":917.0,"90th_percentile":1040.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"112","median_amount":2111.65,"10th_percentile":688.54,"90th_percentile":2908.32},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"1 through 10","median_amount":1087.15,"10th_percentile":787.15,"90th_percentile":1299.87},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"47","median_amount":177.42,"10th_percentile":119.22,"90th_percentile":864.2,"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":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":237.78,"10th_percentile":224.96,"90th_percentile":568.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"221","median_amount":241.16,"10th_percentile":224.27,"90th_percentile":602.35,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"11","median_amount":777.05,"10th_percentile":618.91,"90th_percentile":2103.19},{"payer_name":"Molina","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":160.22,"10th_percentile":96.24,"90th_percentile":259.25,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"92","median_amount":160.22,"10th_percentile":106.0,"90th_percentile":175.97,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"356","median_amount":160.22,"10th_percentile":96.24,"90th_percentile":173.4,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":161.29,"10th_percentile":161.29,"90th_percentile":161.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"185","median_amount":1010.24,"10th_percentile":310.08,"90th_percentile":1668.83,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"39","median_amount":515.76,"10th_percentile":217.92,"90th_percentile":962.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":359.0,"10th_percentile":359.0,"90th_percentile":359.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"337","median_amount":245.06,"10th_percentile":226.98,"90th_percentile":490.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"1 through 10","median_amount":254.76,"10th_percentile":254.76,"90th_percentile":254.76,"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 ($): 104% of Medicare]","count":"1 through 10","median_amount":247.89,"10th_percentile":247.89,"90th_percentile":298.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"200","median_amount":240.66,"10th_percentile":224.17,"90th_percentile":541.78,"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."}]}]},{"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"82","median_amount":1100.74,"10th_percentile":1015.68,"90th_percentile":1100.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":985.8,"10th_percentile":985.8,"90th_percentile":2390.2},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"1 through 10","median_amount":649.32,"10th_percentile":649.32,"90th_percentile":649.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"921","median_amount":540.86,"10th_percentile":498.08,"90th_percentile":541.56,"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":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"165","median_amount":1687.2,"10th_percentile":895.2,"90th_percentile":1989.16},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"111","median_amount":843.6,"10th_percentile":843.6,"90th_percentile":1603.8,"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":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"113","median_amount":1671.44,"10th_percentile":1419.32,"90th_percentile":3501.74},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"159","median_amount":1238.33,"10th_percentile":1142.64,"90th_percentile":1529.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"252","median_amount":1444.0,"10th_percentile":748.65,"90th_percentile":1644.0,"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":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"273","median_amount":1274.0,"10th_percentile":1274.0,"90th_percentile":1349.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"54","median_amount":1274.0,"10th_percentile":1274.0,"90th_percentile":1349.0,"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":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"323","median_amount":541.56,"10th_percentile":499.71,"90th_percentile":541.56,"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":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"306","median_amount":1444.0,"10th_percentile":1155.2,"90th_percentile":1529.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"1 through 10","median_amount":1444.0,"10th_percentile":1444.0,"90th_percentile":1529.0,"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":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"170","median_amount":1895.29,"10th_percentile":975.76,"90th_percentile":3061.99},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"42","median_amount":975.76,"10th_percentile":975.76,"90th_percentile":1576.42},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"1 through 10","median_amount":1895.29,"10th_percentile":1895.29,"90th_percentile":1895.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"19","median_amount":329.03,"10th_percentile":177.42,"90th_percentile":752.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"42","median_amount":543.26,"10th_percentile":501.58,"90th_percentile":543.26,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"623","median_amount":546.95,"10th_percentile":505.16,"90th_percentile":552.45,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"23","median_amount":1586.79,"10th_percentile":1580.6,"90th_percentile":2194.62},{"payer_name":"Molina","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":"25","median_amount":173.4,"10th_percentile":160.22,"90th_percentile":316.37,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":1209.16,"10th_percentile":1209.16,"90th_percentile":1209.16},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"61","median_amount":176.08,"10th_percentile":160.22,"90th_percentile":338.95,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"110","median_amount":161.29,"10th_percentile":160.22,"90th_percentile":319.48,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":299.12,"10th_percentile":299.12,"90th_percentile":299.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"234","median_amount":1209.16,"10th_percentile":1105.56,"90th_percentile":2328.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"51","median_amount":697.38,"10th_percentile":120.46,"90th_percentile":1128.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":1209.16,"10th_percentile":1209.16,"90th_percentile":1209.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"953","median_amount":547.56,"10th_percentile":506.67,"90th_percentile":555.87,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"1 through 10","median_amount":577.88,"10th_percentile":577.88,"90th_percentile":577.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"13","median_amount":561.53,"10th_percentile":518.19,"90th_percentile":564.23,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"535","median_amount":549.75,"10th_percentile":506.36,"90th_percentile":549.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 1 Imaging with Contrast","code_information":[{"code":"5571","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"1 through 10","median_amount":357.38,"10th_percentile":357.38,"90th_percentile":704.56,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 100% of Medicare]","count":"100","median_amount":263.43,"10th_percentile":175.12,"90th_percentile":265.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"1 through 10","median_amount":1046.4,"10th_percentile":537.6,"90th_percentile":1381.8},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":744.3,"10th_percentile":292.2,"90th_percentile":1726.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"14","median_amount":982.15,"10th_percentile":578.29,"90th_percentile":1232.76},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"1 through 10","median_amount":604.8,"10th_percentile":402.05,"90th_percentile":604.8,"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":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"36","median_amount":934.0,"10th_percentile":778.0,"90th_percentile":1110.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"12","median_amount":778.0,"10th_percentile":778.0,"90th_percentile":824.0,"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":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":778.0,"10th_percentile":778.0,"90th_percentile":778.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month 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 ($): 100% of Medicare]","count":"22","median_amount":264.5,"10th_percentile":175.83,"90th_percentile":264.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"27","median_amount":882.0,"10th_percentile":882.0,"90th_percentile":1003.0,"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":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"21","median_amount":1175.46,"10th_percentile":694.22,"90th_percentile":1485.63},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"1 through 10","median_amount":605.17,"10th_percentile":605.17,"90th_percentile":605.17},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":267.0,"10th_percentile":267.0,"90th_percentile":267.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"80","median_amount":266.6,"10th_percentile":177.17,"90th_percentile":268.68,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":979.17,"10th_percentile":979.17,"90th_percentile":979.17},{"payer_name":"Molina","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":274.34,"10th_percentile":274.34,"90th_percentile":274.34,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":74.61,"10th_percentile":74.61,"90th_percentile":74.61,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":111.91,"10th_percentile":74.61,"90th_percentile":112.56,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"18","median_amount":749.92,"10th_percentile":266.77,"90th_percentile":1093.55,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"1 through 10","median_amount":261.6,"10th_percentile":252.0,"90th_percentile":432.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":523.74,"10th_percentile":523.74,"90th_percentile":523.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"83","median_amount":261.08,"10th_percentile":169.02,"90th_percentile":271.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"1 through 10","median_amount":406.95,"10th_percentile":406.95,"90th_percentile":406.95,"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] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"54","median_amount":180.48,"10th_percentile":169.01,"90th_percentile":271.06,"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."}]}]},{"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"1 through 10","median_amount":716.96,"10th_percentile":716.96,"90th_percentile":716.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"1 through 10","median_amount":273.83,"10th_percentile":273.83,"90th_percentile":273.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"95","median_amount":526.86,"10th_percentile":351.31,"90th_percentile":881.44,"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":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"12","median_amount":3886.8,"10th_percentile":1196.77,"90th_percentile":9087.6},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"12","median_amount":2706.0,"10th_percentile":2622.6,"90th_percentile":4778.4,"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":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":4622.59,"10th_percentile":4407.26,"90th_percentile":5308.92},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"1 through 10","median_amount":1208.63,"10th_percentile":806.58,"90th_percentile":5511.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"22","median_amount":1715.48,"10th_percentile":843.39,"90th_percentile":2804.09,"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":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"20","median_amount":1411.0,"10th_percentile":292.9,"90th_percentile":1494.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":1411.0,"10th_percentile":1411.0,"90th_percentile":1696.0,"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":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"33","median_amount":480.03,"10th_percentile":352.74,"90th_percentile":881.31,"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":"Blue Cross","plan_name":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"25","median_amount":1694.0,"10th_percentile":1315.5,"90th_percentile":1922.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"15","median_amount":3535.13,"10th_percentile":2161.68,"90th_percentile":12008.66},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"1 through 10","median_amount":2899.13,"10th_percentile":2899.13,"90th_percentile":3218.07},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"1 through 10","median_amount":5639.07,"10th_percentile":5639.07,"90th_percentile":5639.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"1 through 10","median_amount":7947.0,"10th_percentile":7947.0,"90th_percentile":7947.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":877.74,"10th_percentile":355.21,"90th_percentile":881.64,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"69","median_amount":536.75,"10th_percentile":358.38,"90th_percentile":892.41,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":10306.54,"10th_percentile":10306.54,"90th_percentile":18357.0},{"payer_name":"Molina","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":587.86,"10th_percentile":587.86,"90th_percentile":587.86,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":225.35,"10th_percentile":225.35,"90th_percentile":255.44,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"23","median_amount":302.5,"10th_percentile":183.69,"90th_percentile":426.44,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"29","median_amount":3417.21,"10th_percentile":359.0,"90th_percentile":7893.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"1 through 10","median_amount":1552.88,"10th_percentile":932.88,"90th_percentile":1627.44,"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":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"115","median_amount":532.7,"10th_percentile":354.82,"90th_percentile":891.52,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"1 through 10","median_amount":488.32,"10th_percentile":488.32,"90th_percentile":488.32,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"55","median_amount":534.49,"10th_percentile":358.42,"90th_percentile":891.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 3 Imaging with Contrast","code_information":[{"code":"5573","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"1 through 10","median_amount":2303.06,"10th_percentile":2303.06,"90th_percentile":2303.06,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 100% of Medicare]","count":"1 through 10","median_amount":779.19,"10th_percentile":779.19,"90th_percentile":1210.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"1 through 10","median_amount":19076.4,"10th_percentile":19076.4,"90th_percentile":19076.4},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":5446.46,"10th_percentile":5446.46,"90th_percentile":5446.46},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month 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 ($): 100% of Medicare]","count":"1 through 10","median_amount":780.36,"10th_percentile":780.36,"90th_percentile":1210.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"1 through 10","median_amount":3195.0,"10th_percentile":3195.0,"90th_percentile":3195.0,"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":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"1 through 10","median_amount":1533.35,"10th_percentile":1533.35,"90th_percentile":1533.35},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":781.09,"10th_percentile":781.09,"90th_percentile":781.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"14","median_amount":1144.28,"10th_percentile":785.26,"90th_percentile":1228.67,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":1986.0,"10th_percentile":1986.0,"90th_percentile":1986.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"12","median_amount":1080.46,"10th_percentile":785.67,"90th_percentile":1224.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":1147.69,"10th_percentile":1143.29,"90th_percentile":1224.27,"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 1 Nuclear Medicine and Related Services","code_information":[{"code":"5591","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"1 through 10","median_amount":806.7,"10th_percentile":806.7,"90th_percentile":806.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":397.28,"10th_percentile":395.28,"90th_percentile":1414.79,"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":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"1 through 10","median_amount":986.4,"10th_percentile":986.4,"90th_percentile":1018.8},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":493.2,"10th_percentile":493.2,"90th_percentile":493.2,"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":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":925.83,"10th_percentile":925.83,"90th_percentile":925.83},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"1 through 10","median_amount":1644.0,"10th_percentile":1479.6,"90th_percentile":1698.0,"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":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":1644.0,"10th_percentile":1644.0,"90th_percentile":1644.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":1644.0,"10th_percentile":1644.0,"90th_percentile":1644.0,"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":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"1 through 10","median_amount":1522.05,"10th_percentile":968.0,"90th_percentile":2079.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"1 through 10","median_amount":618.73,"10th_percentile":618.73,"90th_percentile":654.16},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"1 through 10","median_amount":776.77,"10th_percentile":776.77,"90th_percentile":776.77},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":399.23,"10th_percentile":399.23,"90th_percentile":399.23,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":923.02,"10th_percentile":923.02,"90th_percentile":923.02},{"payer_name":"Molina","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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":237.03,"10th_percentile":237.03,"90th_percentile":237.03,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":407.38,"10th_percentile":407.38,"90th_percentile":407.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"1 through 10","median_amount":1645.91,"10th_percentile":1645.91,"90th_percentile":1645.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":407.38,"10th_percentile":399.64,"90th_percentile":407.38,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":404.23,"10th_percentile":404.23,"90th_percentile":1432.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 2 Nuclear Medicine and Related Services","code_information":[{"code":"5592","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"1 through 10","median_amount":1080.6,"10th_percentile":1080.6,"90th_percentile":1080.6,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 100% of Medicare]","count":"22","median_amount":530.49,"10th_percentile":529.49,"90th_percentile":533.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":1522.11,"10th_percentile":1522.11,"90th_percentile":1779.84},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"1 through 10","median_amount":287.52,"10th_percentile":287.52,"90th_percentile":287.52,"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":"Blue Cross","plan_name":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"1 through 10","median_amount":2079.0,"10th_percentile":2079.0,"90th_percentile":2079.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":1832.0,"10th_percentile":1832.0,"90th_percentile":1832.0,"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":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month 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 ($): 100% of Medicare]","count":"1 through 10","median_amount":531.66,"10th_percentile":489.6,"90th_percentile":531.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"1 through 10","median_amount":2079.0,"10th_percentile":2079.0,"90th_percentile":2079.0,"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":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"1 through 10","median_amount":1149.84,"10th_percentile":1149.84,"90th_percentile":1149.84},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"1 through 10","median_amount":4488.86,"10th_percentile":4488.86,"90th_percentile":4488.86},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":529.49,"10th_percentile":529.49,"90th_percentile":529.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"19","median_amount":540.69,"10th_percentile":498.49,"90th_percentile":545.7,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","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":583.92,"10th_percentile":583.92,"90th_percentile":583.92,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":236.93,"10th_percentile":236.93,"90th_percentile":236.93,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":316.27,"10th_percentile":305.42,"90th_percentile":583.92,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":805.03,"10th_percentile":805.03,"90th_percentile":1335.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"1 through 10","median_amount":247.21,"10th_percentile":247.21,"90th_percentile":247.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"16","median_amount":536.95,"10th_percentile":502.54,"90th_percentile":703.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":539.79,"10th_percentile":496.19,"90th_percentile":2586.61,"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."}]}]},{"description":"Level 3 Nuclear Medicine and Related Services","code_information":[{"code":"5593","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"22","median_amount":2620.82,"10th_percentile":2614.3,"90th_percentile":3629.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"171","median_amount":1287.9,"10th_percentile":1284.2,"90th_percentile":1823.56,"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":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"20","median_amount":6129.0,"10th_percentile":2620.82,"90th_percentile":8082.24},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":3064.5,"10th_percentile":3064.5,"90th_percentile":4100.4,"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":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"13","median_amount":5777.32,"10th_percentile":5341.52,"90th_percentile":7685.37},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"16","median_amount":2948.42,"10th_percentile":2948.42,"90th_percentile":2948.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"47","median_amount":2079.0,"10th_percentile":802.71,"90th_percentile":2375.0,"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":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"34","median_amount":1832.0,"10th_percentile":1832.0,"90th_percentile":1940.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":1832.0,"10th_percentile":1832.0,"90th_percentile":1940.0,"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":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"64","median_amount":1289.44,"10th_percentile":1289.44,"90th_percentile":1831.0,"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":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"50","median_amount":2079.0,"10th_percentile":1645.19,"90th_percentile":2201.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"17","median_amount":5456.03,"10th_percentile":2965.57,"90th_percentile":5768.28},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"1 through 10","median_amount":2808.96,"10th_percentile":2808.96,"90th_percentile":2965.57},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"1 through 10","median_amount":762.95,"10th_percentile":762.95,"90th_percentile":762.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":1284.91,"10th_percentile":1284.91,"90th_percentile":1288.1,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"87","median_amount":1302.94,"10th_percentile":1297.04,"90th_percentile":1849.31,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":5744.13,"10th_percentile":5743.96,"90th_percentile":6002.46},{"payer_name":"Molina","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":844.23,"10th_percentile":844.23,"90th_percentile":844.23,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":693.59,"10th_percentile":693.59,"90th_percentile":693.59,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"12","median_amount":693.59,"10th_percentile":108.44,"90th_percentile":888.64,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"36","median_amount":4392.45,"10th_percentile":3465.37,"90th_percentile":7464.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"11","median_amount":1942.8,"10th_percentile":517.44,"90th_percentile":2617.68,"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":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":4392.45,"10th_percentile":4392.45,"90th_percentile":4392.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"177","median_amount":1302.04,"10th_percentile":1297.04,"90th_percentile":1800.19,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"1 through 10","median_amount":1953.81,"10th_percentile":1953.81,"90th_percentile":1953.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"1 through 10","median_amount":1341.02,"10th_percentile":1341.02,"90th_percentile":1341.02,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"94","median_amount":1302.04,"10th_percentile":1297.52,"90th_percentile":1302.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Therapeutic Nuclear Medicine","code_information":[{"code":"5661","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":1832.0,"10th_percentile":1832.0,"90th_percentile":1832.0,"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":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month 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 ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":2315.82,"10th_percentile":2315.82,"90th_percentile":6246.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":2274.51,"10th_percentile":2274.51,"90th_percentile":2274.51,"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."}]}]},{"description":"Level 1 Pathology","code_information":[{"code":"5671","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"1 through 10","median_amount":182.98,"10th_percentile":182.98,"90th_percentile":182.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":52.56,"10th_percentile":48.88,"90th_percentile":52.96,"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":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"1 through 10","median_amount":516.0,"10th_percentile":516.0,"90th_percentile":758.4},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"1 through 10","median_amount":458.0,"10th_percentile":458.0,"90th_percentile":458.0,"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":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":353.0,"10th_percentile":353.0,"90th_percentile":353.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":52.77,"10th_percentile":52.77,"90th_percentile":52.77,"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":"Blue Cross","plan_name":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"1 through 10","median_amount":402.0,"10th_percentile":402.0,"90th_percentile":402.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"1 through 10","median_amount":547.29,"10th_percentile":547.29,"90th_percentile":547.29},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":53.09,"10th_percentile":53.09,"90th_percentile":53.09,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":20.9,"10th_percentile":20.9,"90th_percentile":20.9,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":349.16,"10th_percentile":349.16,"90th_percentile":2943.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"1 through 10","median_amount":206.4,"10th_percentile":206.4,"90th_percentile":206.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":53.09,"10th_percentile":53.09,"90th_percentile":54.17,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":53.09,"10th_percentile":53.09,"90th_percentile":53.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 2 Pathology","code_information":[{"code":"5672","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"1 through 10","median_amount":344.02,"10th_percentile":314.46,"90th_percentile":370.8,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 100% of Medicare]","count":"30","median_amount":168.57,"10th_percentile":154.09,"90th_percentile":169.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"1 through 10","median_amount":949.8,"10th_percentile":314.46,"90th_percentile":1905.6},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":592.8,"10th_percentile":592.8,"90th_percentile":592.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":691.15,"10th_percentile":613.1,"90th_percentile":1503.58},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"1 through 10","median_amount":387.02,"10th_percentile":387.02,"90th_percentile":387.02,"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":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"22","median_amount":426.0,"10th_percentile":402.0,"90th_percentile":458.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"34","median_amount":353.0,"10th_percentile":169.26,"90th_percentile":1069.0,"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":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":402.0,"10th_percentile":169.26,"90th_percentile":633.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month 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 ($): 100% of Medicare]","count":"1 through 10","median_amount":169.26,"10th_percentile":169.26,"90th_percentile":182.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"28","median_amount":402.0,"10th_percentile":321.62,"90th_percentile":1158.0,"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":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"12","median_amount":1007.63,"10th_percentile":178.82,"90th_percentile":1558.95},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"1 through 10","median_amount":1153.58,"10th_percentile":902.9,"90th_percentile":1216.25},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":172.01,"10th_percentile":172.01,"90th_percentile":172.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"31","median_amount":156.26,"10th_percentile":68.5,"90th_percentile":170.95,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","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":93.06,"10th_percentile":93.06,"90th_percentile":137.25,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":45.64,"10th_percentile":44.0,"90th_percentile":48.5,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":91.42,"10th_percentile":90.03,"90th_percentile":137.25,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":787.33,"10th_percentile":642.85,"90th_percentile":2142.26,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"1 through 10","median_amount":627.12,"10th_percentile":312.23,"90th_percentile":1018.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"20","median_amount":170.95,"10th_percentile":170.26,"90th_percentile":184.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"27","median_amount":170.26,"10th_percentile":155.62,"90th_percentile":170.76,"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."}]}]},{"description":"Level 3 Pathology","code_information":[{"code":"5673","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":353.86,"10th_percentile":353.86,"90th_percentile":353.86,"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":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"1 through 10","median_amount":1063.2,"10th_percentile":1063.2,"90th_percentile":1063.2},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":14936.25,"10th_percentile":14936.25,"90th_percentile":14936.25,"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":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":19954.6,"10th_percentile":19954.6,"90th_percentile":19954.6},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"1 through 10","median_amount":10244.07,"10th_percentile":10244.07,"90th_percentile":10244.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"1 through 10","median_amount":458.0,"10th_percentile":458.0,"90th_percentile":458.0,"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":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":353.0,"10th_percentile":353.0,"90th_percentile":2920.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":355.3,"10th_percentile":355.3,"90th_percentile":355.3,"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":"Blue Cross","plan_name":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"1 through 10","median_amount":853.0,"10th_percentile":426.0,"90th_percentile":10788.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"1 through 10","median_amount":2799.13,"10th_percentile":2799.13,"90th_percentile":43084.74},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":357.76,"10th_percentile":357.76,"90th_percentile":357.76,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":358.4,"10th_percentile":358.4,"90th_percentile":358.4,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":214.8,"10th_percentile":214.8,"90th_percentile":214.8,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":101.19,"10th_percentile":97.55,"90th_percentile":191.79,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"1 through 10","median_amount":619.2,"10th_percentile":619.2,"90th_percentile":619.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":357.4,"10th_percentile":357.4,"90th_percentile":358.12,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":364.4,"10th_percentile":364.4,"90th_percentile":364.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 1 Drug Administration","code_information":[{"code":"5691","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"1 through 10","median_amount":3190.3,"10th_percentile":3190.3,"90th_percentile":3190.3,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"1 through 10","median_amount":339.0,"10th_percentile":333.02,"90th_percentile":339.0,"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 ($): 100% of Medicare]","count":"1 through 10","median_amount":545.33,"10th_percentile":275.0,"90th_percentile":3211.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"1 through 10","median_amount":5290.78,"10th_percentile":1452.68,"90th_percentile":9521.26},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"1 through 10","median_amount":1220.58,"10th_percentile":312.59,"90th_percentile":7069.2,"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":"Blue Cross","plan_name":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"1 through 10","median_amount":1825.97,"10th_percentile":1825.97,"90th_percentile":1825.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":2666.0,"10th_percentile":1696.0,"90th_percentile":3900.0,"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":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month 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 ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"1 through 10","median_amount":7689.0,"10th_percentile":7689.0,"90th_percentile":7689.0,"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":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"1 through 10","median_amount":7108.37,"10th_percentile":7108.37,"90th_percentile":38117.62},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"1 through 10","median_amount":1613.0,"10th_percentile":362.04,"90th_percentile":5687.13,"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":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"22","median_amount":8053.32,"10th_percentile":889.69,"90th_percentile":8693.04,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","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":"19","median_amount":71.35,"10th_percentile":16.69,"90th_percentile":388.92,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":339.63,"10th_percentile":27.5,"90th_percentile":497.2,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"72","median_amount":323.32,"10th_percentile":39.84,"90th_percentile":353.48,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":315.19,"10th_percentile":315.19,"90th_percentile":2800.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"1 through 10","median_amount":4053.6,"10th_percentile":4053.6,"90th_percentile":4053.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":1803.91,"10th_percentile":1803.91,"90th_percentile":2916.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":2354.71,"10th_percentile":2354.71,"90th_percentile":2354.71,"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."}]}]},{"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"1 through 10","median_amount":149.57,"10th_percentile":149.57,"90th_percentile":149.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"14","median_amount":244.76,"10th_percentile":241.59,"90th_percentile":3512.64,"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":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"19","median_amount":840.6,"10th_percentile":129.7,"90th_percentile":3638.68},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"14","median_amount":4605.76,"10th_percentile":131.4,"90th_percentile":8301.04,"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":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":1265.51,"10th_percentile":1265.51,"90th_percentile":1323.9},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"11","median_amount":160.74,"10th_percentile":40.19,"90th_percentile":949.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"18","median_amount":2110.7,"10th_percentile":315.0,"90th_percentile":3122.0,"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":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"16","median_amount":2666.0,"10th_percentile":2299.24,"90th_percentile":2666.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":2666.0,"10th_percentile":2666.0,"90th_percentile":2666.0,"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":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":2752.5,"10th_percentile":960.04,"90th_percentile":3512.64,"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":"Blue Cross","plan_name":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"1 through 10","median_amount":2299.24,"10th_percentile":1121.6,"90th_percentile":2993.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"1 through 10","median_amount":3474.0,"10th_percentile":3474.0,"90th_percentile":3474.0,"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":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"1 through 10","median_amount":1190.28,"10th_percentile":691.52,"90th_percentile":1326.66},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"1 through 10","median_amount":159.66,"10th_percentile":159.66,"90th_percentile":629.24},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"1 through 10","median_amount":52.79,"10th_percentile":40.07,"90th_percentile":72.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":1123.16,"10th_percentile":584.68,"90th_percentile":3557.08,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","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":182.02,"10th_percentile":182.02,"90th_percentile":182.02,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":359.0,"10th_percentile":359.0,"90th_percentile":359.0},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":78.9,"10th_percentile":46.65,"90th_percentile":197.02,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"48","median_amount":33.15,"10th_percentile":32.32,"90th_percentile":102.65,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"12","median_amount":359.0,"10th_percentile":205.97,"90th_percentile":359.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"1 through 10","median_amount":154.25,"10th_percentile":154.25,"90th_percentile":183.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"14","median_amount":245.8,"10th_percentile":72.15,"90th_percentile":249.59,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":71.0,"10th_percentile":71.0,"90th_percentile":71.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 3 Drug Administration","code_information":[{"code":"5693","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"24","median_amount":708.24,"10th_percentile":394.62,"90th_percentile":8459.6,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"1 through 10","median_amount":83.6,"10th_percentile":49.96,"90th_percentile":334.84,"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] [APC ($): 100% of Medicare]","count":"110","median_amount":1357.72,"10th_percentile":208.06,"90th_percentile":6122.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"50","median_amount":1486.8,"10th_percentile":422.98,"90th_percentile":4853.63},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"62","median_amount":1798.45,"10th_percentile":409.89,"90th_percentile":27448.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"32","median_amount":1734.08,"10th_percentile":737.73,"90th_percentile":15615.41},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"39","median_amount":475.85,"10th_percentile":475.85,"90th_percentile":7473.35,"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":"Blue Cross","plan_name":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"325","median_amount":1582.51,"10th_percentile":1291.5,"90th_percentile":2666.0,"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":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"33","median_amount":1661.25,"10th_percentile":1572.25,"90th_percentile":2666.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. 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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":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"394","median_amount":1693.95,"10th_percentile":1435.65,"90th_percentile":3025.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"15","median_amount":1572.25,"10th_percentile":1257.8,"90th_percentile":1786.31,"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":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"28","median_amount":1580.87,"10th_percentile":1065.6,"90th_percentile":20260.12},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"1 through 10","median_amount":2577.37,"10th_percentile":2577.37,"90th_percentile":38972.63},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"30","median_amount":1522.95,"10th_percentile":200.22,"90th_percentile":1941.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"75","median_amount":634.23,"10th_percentile":209.33,"90th_percentile":3517.3,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":5423.03,"10th_percentile":5423.03,"90th_percentile":6397.63},{"payer_name":"Molina","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":"32","median_amount":182.02,"10th_percentile":39.59,"90th_percentile":182.02,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":16390.2,"10th_percentile":16390.2,"90th_percentile":16390.2},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"55","median_amount":182.02,"10th_percentile":175.54,"90th_percentile":182.92,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"240","median_amount":182.02,"10th_percentile":152.76,"90th_percentile":265.72,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"57","median_amount":4230.11,"10th_percentile":359.0,"90th_percentile":17099.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"1 through 10","median_amount":373.92,"10th_percentile":146.4,"90th_percentile":13676.16,"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":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":359.0,"10th_percentile":359.0,"90th_percentile":359.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"67","median_amount":675.21,"10th_percentile":213.6,"90th_percentile":4722.71,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"1 through 10","median_amount":3432.64,"10th_percentile":3432.64,"90th_percentile":3432.64,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"53","median_amount":1050.92,"10th_percentile":210.18,"90th_percentile":5902.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 4 Drug Administration","code_information":[{"code":"5694","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"1 through 10","median_amount":36703.16,"10th_percentile":36703.16,"90th_percentile":36703.16,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 100% of Medicare]","count":"13","median_amount":8729.79,"10th_percentile":1220.38,"90th_percentile":8888.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"11","median_amount":6986.82,"10th_percentile":3233.74,"90th_percentile":29319.26},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"39","median_amount":13594.36,"10th_percentile":893.4,"90th_percentile":28502.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"1 through 10","median_amount":6685.66,"10th_percentile":5789.66,"90th_percentile":14778.92,"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":"Blue Cross","plan_name":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"1 through 10","median_amount":5037.36,"10th_percentile":4300.1,"90th_percentile":5596.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":4935.0,"10th_percentile":1795.0,"90th_percentile":4935.0,"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":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month 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 ($): 100% of Medicare]","count":"17","median_amount":2497.77,"10th_percentile":2443.87,"90th_percentile":3989.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"31","median_amount":5597.0,"10th_percentile":5596.96,"90th_percentile":5926.0,"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":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"1 through 10","median_amount":1293.41,"10th_percentile":0.02,"90th_percentile":2586.82},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"24","median_amount":3603.97,"10th_percentile":3533.13,"90th_percentile":11950.18,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":1667.15,"10th_percentile":1667.15,"90th_percentile":1667.15},{"payer_name":"Molina","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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":2784.16,"10th_percentile":2784.16,"90th_percentile":2784.16,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"1 through 10","median_amount":1956.0,"10th_percentile":1956.0,"90th_percentile":1956.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"18","median_amount":3662.56,"10th_percentile":2833.39,"90th_percentile":3712.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":48420.16,"10th_percentile":48420.16,"90th_percentile":48420.16,"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."}]}]},{"description":"Level 1 Diagnostic Tests and Related Services","code_information":[{"code":"5721","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"1 through 10","median_amount":314.1,"10th_percentile":314.1,"90th_percentile":314.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"23","median_amount":155.41,"10th_percentile":141.31,"90th_percentile":155.91,"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":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"1 through 10","median_amount":373.2,"10th_percentile":314.1,"90th_percentile":373.2},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"12","median_amount":186.6,"10th_percentile":186.6,"90th_percentile":186.6,"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":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":351.54,"10th_percentile":317.22,"90th_percentile":354.54},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"11","median_amount":353.36,"10th_percentile":353.36,"90th_percentile":353.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"1 through 10","median_amount":542.0,"10th_percentile":435.4,"90th_percentile":622.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"15","median_amount":622.0,"10th_percentile":622.0,"90th_percentile":622.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":622.0,"10th_percentile":622.0,"90th_percentile":622.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":154.54,"10th_percentile":141.49,"90th_percentile":154.54,"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":"Blue Cross","plan_name":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"15","median_amount":497.6,"10th_percentile":422.0,"90th_percentile":622.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"1 through 10","median_amount":497.6,"10th_percentile":497.6,"90th_percentile":497.6,"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":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"1 through 10","median_amount":419.23,"10th_percentile":419.23,"90th_percentile":419.23},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"1 through 10","median_amount":215.83,"10th_percentile":215.83,"90th_percentile":215.83},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"15","median_amount":157.65,"10th_percentile":155.75,"90th_percentile":158.62,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":350.29,"10th_percentile":350.29,"90th_percentile":350.29},{"payer_name":"Molina","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":69.97,"10th_percentile":69.97,"90th_percentile":69.97,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":69.97,"10th_percentile":69.97,"90th_percentile":69.97,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"14","median_amount":267.46,"10th_percentile":267.46,"90th_percentile":267.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"1 through 10","median_amount":149.28,"10th_percentile":149.28,"90th_percentile":149.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"16","median_amount":156.08,"10th_percentile":145.23,"90th_percentile":158.62,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"14","median_amount":158.62,"10th_percentile":158.62,"90th_percentile":158.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 2 Diagnostic Tests and Related Services","code_information":[{"code":"5722","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"11","median_amount":625.16,"10th_percentile":577.88,"90th_percentile":625.16,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 100% of Medicare]","count":"81","median_amount":307.83,"10th_percentile":283.56,"90th_percentile":308.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"18","median_amount":1624.8,"10th_percentile":577.8,"90th_percentile":2433.0},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"13","median_amount":646.8,"10th_percentile":646.8,"90th_percentile":1149.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"12","median_amount":2037.03,"10th_percentile":1214.17,"90th_percentile":2162.9},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"40","median_amount":703.31,"10th_percentile":703.31,"90th_percentile":703.31,"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":"Blue Cross","plan_name":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"24","median_amount":1329.0,"10th_percentile":292.0,"90th_percentile":1644.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"31","median_amount":296.0,"10th_percentile":280.0,"90th_percentile":1274.0,"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":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":280.0,"10th_percentile":280.0,"90th_percentile":1274.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month 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 ($): 100% of Medicare]","count":"24","median_amount":307.58,"10th_percentile":284.32,"90th_percentile":562.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"47","median_amount":1063.0,"10th_percentile":307.58,"90th_percentile":1529.0,"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":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"1 through 10","median_amount":365.0,"10th_percentile":365.0,"90th_percentile":365.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"23","median_amount":1536.46,"10th_percentile":1329.01,"90th_percentile":2581.42},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"1 through 10","median_amount":1329.01,"10th_percentile":701.29,"90th_percentile":1403.03},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"1 through 10","median_amount":27.63,"10th_percentile":27.63,"90th_percentile":27.63,"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":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":310.23,"10th_percentile":310.23,"90th_percentile":310.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"67","median_amount":311.78,"10th_percentile":309.4,"90th_percentile":544.15,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":1710.74,"10th_percentile":1710.74,"90th_percentile":1710.74},{"payer_name":"Molina","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":239.04,"10th_percentile":239.04,"90th_percentile":239.04,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":26.09,"10th_percentile":26.09,"90th_percentile":26.09,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"22","median_amount":135.16,"10th_percentile":26.09,"90th_percentile":239.04,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"53","median_amount":1099.51,"10th_percentile":919.2,"90th_percentile":1662.55,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"1 through 10","median_amount":919.2,"10th_percentile":919.2,"90th_percentile":949.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"82","median_amount":309.9,"10th_percentile":286.9,"90th_percentile":315.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 104% of Medicare]","count":"1 through 10","median_amount":841.93,"10th_percentile":841.93,"90th_percentile":841.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"48","median_amount":309.9,"10th_percentile":289.69,"90th_percentile":444.43,"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."}]}]},{"description":"Level 3 Diagnostic Tests and Related Services","code_information":[{"code":"5723","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":521.96,"10th_percentile":521.96,"90th_percentile":521.96,"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":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":883.5,"10th_percentile":883.5,"90th_percentile":883.5,"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":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":1288.6,"10th_percentile":1288.6,"90th_percentile":1288.6},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"1 through 10","median_amount":1644.0,"10th_percentile":1644.0,"90th_percentile":1644.0,"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":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"1 through 10","median_amount":1444.0,"10th_percentile":1244.0,"90th_percentile":1644.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"1 through 10","median_amount":186.02,"10th_percentile":186.02,"90th_percentile":186.02},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":531.68,"10th_percentile":531.68,"90th_percentile":533.1,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":108.44,"10th_percentile":108.44,"90th_percentile":108.44,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":1131.76,"10th_percentile":1131.76,"90th_percentile":1131.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"1 through 10","median_amount":508.08,"10th_percentile":508.08,"90th_percentile":652.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":532.18,"10th_percentile":532.18,"90th_percentile":532.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 4 Diagnostic Tests and Related Services","code_information":[{"code":"5724","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 100% of Medicare]","count":"1 through 10","median_amount":1355.83,"10th_percentile":1355.83,"90th_percentile":1355.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"1 through 10","median_amount":3104.37,"10th_percentile":3104.37,"90th_percentile":3104.37,"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":"Blue Cross","plan_name":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month 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 ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"1 through 10","median_amount":6626.0,"10th_percentile":6626.0,"90th_percentile":6626.0,"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":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":1374.5,"10th_percentile":1374.5,"90th_percentile":2216.05,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":3453.02,"10th_percentile":3453.02,"90th_percentile":5466.94,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"1 through 10","median_amount":2021.28,"10th_percentile":2021.28,"90th_percentile":2021.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":1299.38,"10th_percentile":1299.38,"90th_percentile":1299.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% 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":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"1 through 10","median_amount":798.88,"10th_percentile":798.88,"90th_percentile":798.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"31","median_amount":807.35,"10th_percentile":50.0,"90th_percentile":1776.17,"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":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":1549.2,"10th_percentile":1549.2,"90th_percentile":2330.4,"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":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":1267.66,"10th_percentile":1267.66,"90th_percentile":1699.2,"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":"Blue Cross","plan_name":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"33","median_amount":120.94,"10th_percentile":120.94,"90th_percentile":120.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"1 through 10","median_amount":1617.6,"10th_percentile":1617.6,"90th_percentile":1831.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"18","median_amount":1062.4,"10th_percentile":542.6,"90th_percentile":1521.68,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","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":33.06,"10th_percentile":33.06,"90th_percentile":33.06,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":1342.46,"10th_percentile":633.43,"90th_percentile":1795.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":695.54,"10th_percentile":695.54,"90th_percentile":827.28,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":325.58,"10th_percentile":325.58,"90th_percentile":325.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 2 Minor Procedures","code_information":[{"code":"5732","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"21","median_amount":78.8,"10th_percentile":73.84,"90th_percentile":78.8,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":39.4,"10th_percentile":39.4,"90th_percentile":39.4},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 100% of Medicare]","count":"168","median_amount":39.4,"10th_percentile":38.61,"90th_percentile":39.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"39","median_amount":240.6,"10th_percentile":78.8,"90th_percentile":617.76},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"37","median_amount":120.3,"10th_percentile":120.3,"90th_percentile":127.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"32","median_amount":225.83,"10th_percentile":201.44,"90th_percentile":296.45},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"64","median_amount":88.65,"10th_percentile":88.65,"90th_percentile":88.65,"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":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"65","median_amount":401.0,"10th_percentile":340.0,"90th_percentile":401.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"61","median_amount":401.0,"10th_percentile":401.0,"90th_percentile":425.0,"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":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"17","median_amount":401.0,"10th_percentile":401.0,"90th_percentile":425.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month 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 ($): 100% of Medicare]","count":"63","median_amount":38.77,"10th_percentile":36.33,"90th_percentile":38.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"66","median_amount":401.0,"10th_percentile":201.0,"90th_percentile":425.0,"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":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"1 through 10","median_amount":320.8,"10th_percentile":320.8,"90th_percentile":320.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"46","median_amount":270.27,"10th_percentile":139.15,"90th_percentile":286.03},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"1 through 10","median_amount":139.15,"10th_percentile":139.15,"90th_percentile":21270.26},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"1 through 10","median_amount":39.19,"10th_percentile":39.19,"90th_percentile":39.19,"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":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":39.4,"10th_percentile":39.4,"90th_percentile":39.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"127","median_amount":39.79,"10th_percentile":39.07,"90th_percentile":39.79,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":225.14,"10th_percentile":225.14,"90th_percentile":239.34},{"payer_name":"Molina","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":37.67,"10th_percentile":37.67,"90th_percentile":37.67,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":35.63,"10th_percentile":35.63,"90th_percentile":37.67,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"37","median_amount":35.63,"10th_percentile":35.63,"90th_percentile":37.67,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":35.63,"10th_percentile":35.63,"90th_percentile":35.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"79","median_amount":172.43,"10th_percentile":172.43,"90th_percentile":174.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"1 through 10","median_amount":96.24,"10th_percentile":96.24,"90th_percentile":105.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"165","median_amount":39.5,"10th_percentile":39.0,"90th_percentile":39.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"1 through 10","median_amount":41.37,"10th_percentile":41.37,"90th_percentile":41.37,"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 ($): 104% of Medicare]","count":"1 through 10","median_amount":40.76,"10th_percentile":40.16,"90th_percentile":40.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"106","median_amount":39.49,"10th_percentile":38.99,"90th_percentile":39.79,"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."}]}]},{"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":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"51","median_amount":119.24,"10th_percentile":112.62,"90th_percentile":119.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"218","median_amount":59.62,"10th_percentile":55.58,"90th_percentile":117.16,"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":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"60","median_amount":457.2,"10th_percentile":119.24,"90th_percentile":577.2},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"38","median_amount":234.0,"10th_percentile":163.2,"90th_percentile":256.5,"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":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"74","median_amount":429.51,"10th_percentile":306.36,"90th_percentile":560.89},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"77","median_amount":134.15,"10th_percentile":134.15,"90th_percentile":134.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"127","median_amount":698.4,"10th_percentile":127.16,"90th_percentile":823.01,"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":"Blue Cross","plan_name":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"118","median_amount":633.0,"10th_percentile":544.0,"90th_percentile":670.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"35","median_amount":633.0,"10th_percentile":576.0,"90th_percentile":670.0,"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":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"1 through 10","median_amount":544.0,"10th_percentile":544.0,"90th_percentile":544.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"100","median_amount":58.67,"10th_percentile":55.41,"90th_percentile":410.69,"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":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"150","median_amount":720.0,"10th_percentile":520.0,"90th_percentile":762.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"1 through 10","median_amount":720.0,"10th_percentile":720.0,"90th_percentile":720.0,"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":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"76","median_amount":513.6,"10th_percentile":366.66,"90th_percentile":822.99},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"17","median_amount":264.41,"10th_percentile":188.77,"90th_percentile":416.75},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"1 through 10","median_amount":18.56,"10th_percentile":18.36,"90th_percentile":29.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":58.43,"10th_percentile":58.43,"90th_percentile":59.62,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"209","median_amount":60.22,"10th_percentile":59.02,"90th_percentile":421.32,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":439.97,"10th_percentile":411.54,"90th_percentile":685.45},{"payer_name":"Molina","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":16.69,"10th_percentile":16.69,"90th_percentile":26.29,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":34.69,"10th_percentile":34.69,"90th_percentile":110.2,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"18","median_amount":24.39,"10th_percentile":16.69,"90th_percentile":31.8,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"107","median_amount":335.4,"10th_percentile":233.92,"90th_percentile":421.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"56","median_amount":193.44,"10th_percentile":130.56,"90th_percentile":239.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":787.58,"10th_percentile":787.58,"90th_percentile":787.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"209","median_amount":59.52,"10th_percentile":56.87,"90th_percentile":541.94,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"1 through 10","median_amount":62.6,"10th_percentile":62.6,"90th_percentile":62.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"1 through 10","median_amount":61.06,"10th_percentile":58.39,"90th_percentile":61.88,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"109","median_amount":59.52,"10th_percentile":56.63,"90th_percentile":947.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 4 Minor Procedures","code_information":[{"code":"5734","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"63","median_amount":258.78,"10th_percentile":235.18,"90th_percentile":258.78,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 100% of Medicare]","count":"239","median_amount":126.8,"10th_percentile":115.24,"90th_percentile":127.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"82","median_amount":400.2,"10th_percentile":179.4,"90th_percentile":990.6},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"56","median_amount":368.7,"10th_percentile":140.1,"90th_percentile":1721.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"71","median_amount":567.3,"10th_percentile":170.43,"90th_percentile":929.78},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"97","median_amount":291.13,"10th_percentile":291.13,"90th_percentile":291.13,"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":"Blue Cross","plan_name":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"130","median_amount":458.0,"10th_percentile":299.0,"90th_percentile":963.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"105","median_amount":544.0,"10th_percentile":280.0,"90th_percentile":778.0,"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":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"23","median_amount":633.0,"10th_percentile":353.0,"90th_percentile":670.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month 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 ($): 100% of Medicare]","count":"87","median_amount":127.32,"10th_percentile":115.71,"90th_percentile":127.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"163","median_amount":426.0,"10th_percentile":299.0,"90th_percentile":823.0,"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":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"1 through 10","median_amount":658.4,"10th_percentile":658.4,"90th_percentile":823.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"106","median_amount":449.56,"10th_percentile":201.53,"90th_percentile":1112.77},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"15","median_amount":315.43,"10th_percentile":155.81,"90th_percentile":1167.23},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"1 through 10","median_amount":39.19,"10th_percentile":39.19,"90th_percentile":58.79,"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":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":129.39,"10th_percentile":127.8,"90th_percentile":129.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"251","median_amount":128.59,"10th_percentile":128.07,"90th_percentile":130.68,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"18","median_amount":178.25,"10th_percentile":167.87,"90th_percentile":939.87},{"payer_name":"Molina","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":"15","median_amount":37.25,"10th_percentile":21.22,"90th_percentile":3031.53,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"43","median_amount":37.67,"10th_percentile":12.56,"90th_percentile":106.24,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"128","median_amount":302.29,"10th_percentile":128.57,"90th_percentile":709.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"30","median_amount":294.96,"10th_percentile":153.12,"90th_percentile":312.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"246","median_amount":128.07,"10th_percentile":116.6,"90th_percentile":130.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"1 through 10","median_amount":135.85,"10th_percentile":135.85,"90th_percentile":135.85,"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 ($): 104% of Medicare]","count":"1 through 10","median_amount":119.84,"10th_percentile":119.84,"90th_percentile":131.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"133","median_amount":128.37,"10th_percentile":117.29,"90th_percentile":130.68,"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 1 Electronic Analysis of Devices","code_information":[{"code":"5741","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"1 through 10","median_amount":74.86,"10th_percentile":74.86,"90th_percentile":74.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"21","median_amount":36.76,"10th_percentile":34.02,"90th_percentile":37.43,"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":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"1 through 10","median_amount":757.2,"10th_percentile":757.2,"90th_percentile":1262.0},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":378.6,"10th_percentile":378.6,"90th_percentile":378.6,"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":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":714.99,"10th_percentile":710.97,"90th_percentile":752.38},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"1 through 10","median_amount":84.22,"10th_percentile":84.22,"90th_percentile":84.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"1 through 10","median_amount":902.7,"10th_percentile":882.0,"90th_percentile":1063.0,"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":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":778.0,"10th_percentile":778.0,"90th_percentile":824.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"12","median_amount":36.83,"10th_percentile":36.83,"90th_percentile":36.83,"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":"Blue Cross","plan_name":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"11","median_amount":882.0,"10th_percentile":682.0,"90th_percentile":1063.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"1 through 10","median_amount":850.59,"10th_percentile":850.59,"90th_percentile":899.13},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"1 through 10","median_amount":437.91,"10th_percentile":437.91,"90th_percentile":437.91},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":37.43,"10th_percentile":37.43,"90th_percentile":37.43,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"18","median_amount":37.2,"10th_percentile":37.04,"90th_percentile":37.8,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":708.55,"10th_percentile":708.55,"90th_percentile":708.55},{"payer_name":"Molina","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":26.09,"10th_percentile":26.09,"90th_percentile":26.09,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":25.12,"10th_percentile":25.12,"90th_percentile":26.09,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":542.66,"10th_percentile":542.66,"90th_percentile":547.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"1 through 10","median_amount":302.88,"10th_percentile":302.88,"90th_percentile":312.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"26","median_amount":37.35,"10th_percentile":37.05,"90th_percentile":37.8,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"17","median_amount":37.54,"10th_percentile":37.34,"90th_percentile":37.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Cardiac Rehabilitation","code_information":[{"code":"5771","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"21","median_amount":1263.9,"10th_percentile":505.56,"90th_percentile":2780.58,"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":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 100% of Medicare]","count":"256","median_amount":994.08,"10th_percentile":358.83,"90th_percentile":1491.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"31","median_amount":1491.0,"10th_percentile":894.6,"90th_percentile":3578.4},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":1735.8,"10th_percentile":1735.8,"90th_percentile":1735.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"17","median_amount":1953.28,"10th_percentile":837.12,"90th_percentile":3348.48},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"25","median_amount":2559.42,"10th_percentile":1137.52,"90th_percentile":3696.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"353","median_amount":365.0,"10th_percentile":280.0,"90th_percentile":387.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"202","median_amount":280.0,"10th_percentile":280.0,"90th_percentile":296.0,"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":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"59","median_amount":280.0,"10th_percentile":280.0,"90th_percentile":296.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month 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 ($): 100% of Medicare]","count":"59","median_amount":808.88,"10th_percentile":359.07,"90th_percentile":1368.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"366","median_amount":315.0,"10th_percentile":315.0,"90th_percentile":334.0,"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":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"37","median_amount":315.0,"10th_percentile":252.0,"90th_percentile":315.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"26","median_amount":1724.6,"10th_percentile":669.96,"90th_percentile":3894.0},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"11","median_amount":910.0,"10th_percentile":182.0,"90th_percentile":1724.6},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":994.88,"10th_percentile":994.88,"90th_percentile":994.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"111","median_amount":968.0,"10th_percentile":251.4,"90th_percentile":1508.4,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":1953.28,"10th_percentile":1953.28,"90th_percentile":1953.28},{"payer_name":"Molina","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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":2350.81,"10th_percentile":2350.81,"90th_percentile":2350.81},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"35","median_amount":96.29,"10th_percentile":96.29,"90th_percentile":96.29,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"27","median_amount":1068.55,"10th_percentile":431.32,"90th_percentile":2372.26,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"1 through 10","median_amount":1192.8,"10th_percentile":1192.8,"90th_percentile":1192.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"143","median_amount":1083.69,"10th_percentile":250.4,"90th_percentile":1531.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"127","median_amount":1000.83,"10th_percentile":250.21,"90th_percentile":1501.25,"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."}]}]},{"description":"Resuscitation and Cardioversion","code_information":[{"code":"5781","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"24","median_amount":646.34,"10th_percentile":643.71,"90th_percentile":1183.07,"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":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"1 through 10","median_amount":5223.0,"10th_percentile":4716.0,"90th_percentile":7000.8},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":4021.8,"10th_percentile":4021.8,"90th_percentile":4021.8,"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":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"1 through 10","median_amount":1477.91,"10th_percentile":1477.91,"90th_percentile":3041.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"1 through 10","median_amount":7237.0,"10th_percentile":2291.9,"90th_percentile":11191.83,"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":"Blue Cross","plan_name":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":4446.0,"10th_percentile":3902.0,"90th_percentile":9757.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"18","median_amount":646.34,"10th_percentile":646.34,"90th_percentile":1705.3,"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":"Blue Cross","plan_name":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"1 through 10","median_amount":8262.4,"10th_percentile":8262.4,"90th_percentile":11578.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"1 through 10","median_amount":8277.39,"10th_percentile":861.97,"90th_percentile":10912.73},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":647.61,"10th_percentile":647.61,"90th_percentile":647.61,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"13","median_amount":1199.76,"10th_percentile":652.81,"90th_percentile":1595.68,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":416.84,"10th_percentile":416.84,"90th_percentile":416.84,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":2800.0,"10th_percentile":2597.0,"90th_percentile":3197.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"1 through 10","median_amount":1407.06,"10th_percentile":967.69,"90th_percentile":3266.17,"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":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"22","median_amount":1197.33,"10th_percentile":650.36,"90th_percentile":1517.27,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"23","median_amount":658.05,"10th_percentile":657.15,"90th_percentile":1202.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Pulmonary Treatment","code_information":[{"code":"5791","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"1 through 10","median_amount":295.8,"10th_percentile":295.8,"90th_percentile":295.8},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":763.74,"10th_percentile":763.74,"90th_percentile":763.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month 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 ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":40.87,"10th_percentile":40.87,"90th_percentile":40.87,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":99.22,"10th_percentile":99.22,"90th_percentile":132.37,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inj, vancomycin hcl (mylan)","code_information":[{"code":"9221","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":18.89,"10th_percentile":18.89,"90th_percentile":18.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inj, clindamycin phosp 300mg","code_information":[{"code":"9291","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month 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 ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","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":11.59,"10th_percentile":11.59,"90th_percentile":11.59,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Platelet pheres leukoreduced","code_information":[{"code":"9501","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":1034.98,"10th_percentile":1034.98,"90th_percentile":1034.98,"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":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"RBC leukocytes reduced","code_information":[{"code":"9512","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month 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 ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":78.35,"10th_percentile":78.35,"90th_percentile":78.35,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"RBC leukoreduced irradiated","code_information":[{"code":"9522","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":2277.36,"10th_percentile":2277.36,"90th_percentile":2277.36,"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":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"1 through 10","median_amount":2738.0,"10th_percentile":2402.0,"90th_percentile":2738.0,"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":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":2119.0,"10th_percentile":2119.0,"90th_percentile":2119.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":1203.99,"10th_percentile":1203.99,"90th_percentile":1203.99,"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":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"1 through 10","median_amount":2402.0,"10th_percentile":2402.0,"90th_percentile":2402.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":1379.11,"10th_percentile":1150.08,"90th_percentile":3558.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":1278.12,"10th_percentile":1278.12,"90th_percentile":1278.12,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Plate pheres leukoredu irrad","code_information":[{"code":"9530","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"1 through 10","median_amount":2538.8,"10th_percentile":2538.8,"90th_percentile":2538.8,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 100% of Medicare]","count":"11","median_amount":1303.1,"10th_percentile":1092.2,"90th_percentile":3985.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"1 through 10","median_amount":4312.8,"10th_percentile":4312.8,"90th_percentile":4312.8},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":1731.3,"10th_percentile":1731.3,"90th_percentile":1731.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":10045.04,"10th_percentile":10045.04,"90th_percentile":10045.04},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"1 through 10","median_amount":2402.0,"10th_percentile":2402.0,"90th_percentile":2737.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":2119.0,"10th_percentile":2119.0,"90th_percentile":5565.0,"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":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month 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 ($): 100% of Medicare]","count":"13","median_amount":3014.19,"10th_percentile":1479.61,"90th_percentile":8060.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"16","median_amount":2402.0,"10th_percentile":2402.0,"90th_percentile":2402.0,"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":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":1430.13,"10th_percentile":1430.13,"90th_percentile":1430.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"16","median_amount":1714.77,"10th_percentile":1235.67,"90th_percentile":4146.71,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":1641.55,"10th_percentile":604.29,"90th_percentile":1641.55,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":2863.37,"10th_percentile":2208.05,"90th_percentile":6356.08,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":1376.92,"10th_percentile":796.82,"90th_percentile":4104.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":1451.68,"10th_percentile":1451.68,"90th_percentile":1451.68,"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":"Non-OPPS Clinic Services","code_information":[{"code":"N700","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"1 through 10","median_amount":406.2,"10th_percentile":406.2,"90th_percentile":449.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"31","median_amount":406.2,"10th_percentile":54.63,"90th_percentile":449.4},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":288.9,"10th_percentile":203.1,"90th_percentile":600.3,"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":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"11","median_amount":380.1,"10th_percentile":174.05,"90th_percentile":835.91},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"153","median_amount":310.0,"10th_percentile":252.0,"90th_percentile":365.0,"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":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"60","median_amount":280.0,"10th_percentile":280.0,"90th_percentile":296.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"13","median_amount":280.0,"10th_percentile":280.0,"90th_percentile":296.0,"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":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"1 through 10","median_amount":365.0,"10th_percentile":365.0,"90th_percentile":365.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":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":"Blue Cross","plan_name":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"104","median_amount":310.0,"10th_percentile":204.0,"90th_percentile":328.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"1 through 10","median_amount":387.0,"10th_percentile":387.0,"90th_percentile":387.0,"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":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"43","median_amount":504.83,"10th_percentile":221.75,"90th_percentile":555.38},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"1 through 10","median_amount":234.92,"10th_percentile":234.92,"90th_percentile":234.92},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"1 through 10","median_amount":504.83,"10th_percentile":504.83,"90th_percentile":504.83},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"1 through 10","median_amount":824.0,"10th_percentile":824.0,"90th_percentile":824.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":310.0,"10th_percentile":310.0,"90th_percentile":310.0},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":108.73,"10th_percentile":73.77,"90th_percentile":224.42,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":1.07,"10th_percentile":1.07,"90th_percentile":1.07,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"49","median_amount":359.0,"10th_percentile":309.0,"90th_percentile":359.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":310.0,"10th_percentile":310.0,"90th_percentile":310.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Clinical Diagnostic Lab Services","code_information":[{"code":"N800","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"71","median_amount":48.04,"10th_percentile":18.0,"90th_percentile":100.8,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":1000.45,"10th_percentile":1000.45,"90th_percentile":1000.45},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"1 through 10","median_amount":14.72,"10th_percentile":9.88,"90th_percentile":39.82,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"255","median_amount":27.74,"10th_percentile":12.5,"90th_percentile":43.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"123","median_amount":130.8,"10th_percentile":32.46,"90th_percentile":640.8},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"66","median_amount":70.8,"10th_percentile":66.6,"90th_percentile":285.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"68","median_amount":132.62,"10th_percentile":106.12,"90th_percentile":238.22},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"142","median_amount":54.05,"10th_percentile":35.01,"90th_percentile":81.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"179","median_amount":282.0,"10th_percentile":118.0,"90th_percentile":458.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"151","median_amount":236.0,"10th_percentile":118.0,"90th_percentile":353.0,"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":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"27","median_amount":236.0,"10th_percentile":182.0,"90th_percentile":426.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month 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 ($): 100% of Medicare]","count":"101","median_amount":29.13,"10th_percentile":23.38,"90th_percentile":40.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"181","median_amount":236.0,"10th_percentile":79.0,"90th_percentile":402.0,"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":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"1 through 10","median_amount":458.0,"10th_percentile":458.0,"90th_percentile":458.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"141","median_amount":165.81,"10th_percentile":75.65,"90th_percentile":716.47},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"14","median_amount":87.79,"10th_percentile":40.95,"90th_percentile":263.73},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"14","median_amount":14.11,"10th_percentile":3.01,"90th_percentile":718.36,"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":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":28.31,"10th_percentile":25.06,"90th_percentile":28.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"221","median_amount":28.58,"10th_percentile":12.63,"90th_percentile":40.68,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"103","median_amount":284.96,"10th_percentile":52.44,"90th_percentile":627.14},{"payer_name":"Molina","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":"37","median_amount":11.94,"10th_percentile":4.33,"90th_percentile":2646.93,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"34","median_amount":40.12,"10th_percentile":6.74,"90th_percentile":127.24,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"159","median_amount":7.96,"10th_percentile":3.16,"90th_percentile":42.31,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"177","median_amount":101.48,"10th_percentile":50.74,"90th_percentile":359.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"45","median_amount":56.64,"10th_percentile":17.95,"90th_percentile":113.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":236.0,"10th_percentile":236.0,"90th_percentile":236.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"269","median_amount":28.58,"10th_percentile":14.26,"90th_percentile":41.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"1 through 10","median_amount":160.59,"10th_percentile":28.39,"90th_percentile":178.15,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"11","median_amount":28.85,"10th_percentile":24.48,"90th_percentile":34.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"187","median_amount":28.02,"10th_percentile":12.63,"90th_percentile":35.79,"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."}]}]},{"description":"Therapy Services","code_information":[{"code":"N801","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"180","median_amount":601.66,"10th_percentile":204.32,"90th_percentile":1380.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"49","median_amount":23.38,"10th_percentile":22.73,"90th_percentile":217.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1861","median_amount":267.42,"10th_percentile":81.89,"90th_percentile":550.53,"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":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"379","median_amount":824.4,"10th_percentile":220.88,"90th_percentile":2088.03},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"398","median_amount":1218.6,"10th_percentile":376.2,"90th_percentile":2588.4,"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":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"224","median_amount":1067.76,"10th_percentile":355.92,"90th_percentile":2534.7},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"161","median_amount":226.01,"10th_percentile":164.59,"90th_percentile":854.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. 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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":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. 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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":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"1603","median_amount":390.0,"10th_percentile":330.41,"90th_percentile":454.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"18","median_amount":418.0,"10th_percentile":301.0,"90th_percentile":534.0,"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":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"352","median_amount":1184.23,"10th_percentile":372.72,"90th_percentile":2961.57},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"53","median_amount":841.48,"10th_percentile":264.41,"90th_percentile":1626.53},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"1 through 10","median_amount":164.53,"10th_percentile":164.53,"90th_percentile":164.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"16","median_amount":311.74,"10th_percentile":252.45,"90th_percentile":515.43,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"906","median_amount":252.1,"10th_percentile":97.9,"90th_percentile":521.08,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"21","median_amount":1149.41,"10th_percentile":385.15,"90th_percentile":1982.48},{"payer_name":"Molina","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":22.7,"10th_percentile":22.7,"90th_percentile":179.83,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":876.58,"10th_percentile":545.67,"90th_percentile":2167.63},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"17","median_amount":188.64,"10th_percentile":149.57,"90th_percentile":1101.68,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1822","median_amount":156.82,"10th_percentile":22.07,"90th_percentile":213.88,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":179.83,"10th_percentile":179.83,"90th_percentile":179.83,"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":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"438","median_amount":866.88,"10th_percentile":237.79,"90th_percentile":1905.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"44","median_amount":642.24,"10th_percentile":188.97,"90th_percentile":1538.64,"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":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":734.01,"10th_percentile":186.14,"90th_percentile":4361.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1232","median_amount":255.69,"10th_percentile":97.91,"90th_percentile":549.32,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"1 through 10","median_amount":3461.68,"10th_percentile":3461.68,"90th_percentile":3461.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"23","median_amount":200.92,"10th_percentile":101.11,"90th_percentile":501.22,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"884","median_amount":285.92,"10th_percentile":98.4,"90th_percentile":560.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Durable Medical Equipment","code_information":[{"code":"N805","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"1 through 10","median_amount":2010.94,"10th_percentile":810.0,"90th_percentile":2494.54,"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":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 100% of Medicare]","count":"12","median_amount":481.96,"10th_percentile":188.73,"90th_percentile":625.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"1 through 10","median_amount":1321.32,"10th_percentile":1321.32,"90th_percentile":1321.32},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":441.6,"10th_percentile":441.6,"90th_percentile":441.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":871.0,"10th_percentile":871.0,"90th_percentile":871.0},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"1 through 10","median_amount":650.0,"10th_percentile":310.0,"90th_percentile":1274.78,"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":"Blue Cross","plan_name":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"1 through 10","median_amount":486.0,"10th_percentile":486.0,"90th_percentile":486.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":486.0,"10th_percentile":486.0,"90th_percentile":486.0,"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":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month 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 ($): 100% of Medicare]","count":"1 through 10","median_amount":215.96,"10th_percentile":215.96,"90th_percentile":215.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"1 through 10","median_amount":374.4,"10th_percentile":186.0,"90th_percentile":486.0,"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":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"1 through 10","median_amount":107.57,"10th_percentile":107.57,"90th_percentile":527.31},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":94.37,"10th_percentile":94.37,"90th_percentile":94.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":232.82,"10th_percentile":217.81,"90th_percentile":462.21,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":546.1,"10th_percentile":546.1,"90th_percentile":1520.05,"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":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"1 through 10","median_amount":464.76,"10th_percentile":464.76,"90th_percentile":464.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":221.65,"10th_percentile":221.65,"90th_percentile":221.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":462.21,"10th_percentile":190.62,"90th_percentile":650.94,"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."}]}]},{"description":"Other Medicine","code_information":[{"code":"N809","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"1 through 10","median_amount":83.6,"10th_percentile":83.6,"90th_percentile":83.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"13","median_amount":194.79,"10th_percentile":178.85,"90th_percentile":344.07,"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":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":720.0,"10th_percentile":720.0,"90th_percentile":720.0,"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":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":1187.06,"10th_percentile":555.2,"90th_percentile":1723.16},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"12","median_amount":350.0,"10th_percentile":207.4,"90th_percentile":390.0,"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":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":347.0,"10th_percentile":347.0,"90th_percentile":347.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"1 through 10","median_amount":347.0,"10th_percentile":347.0,"90th_percentile":347.0,"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":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":354.14,"10th_percentile":141.83,"90th_percentile":429.31,"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":"Blue Cross","plan_name":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"1 through 10","median_amount":390.0,"10th_percentile":312.01,"90th_percentile":413.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"1 through 10","median_amount":537.18,"10th_percentile":284.24,"90th_percentile":808.81},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"13","median_amount":197.03,"10th_percentile":140.08,"90th_percentile":318.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":724.55,"10th_percentile":724.55,"90th_percentile":724.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"11","median_amount":185.26,"10th_percentile":142.12,"90th_percentile":323.67,"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":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"1 through 10","median_amount":395.26,"10th_percentile":395.26,"90th_percentile":395.26,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":222.03,"10th_percentile":138.24,"90th_percentile":645.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Observation, Other","code_information":[{"code":"N811","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month 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 ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"1 through 10","median_amount":2034.0,"10th_percentile":2034.0,"90th_percentile":2034.0,"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":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-covered Services","code_information":[{"code":"N900","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"1 through 10","median_amount":21.65,"10th_percentile":21.65,"90th_percentile":21.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"1 through 10","median_amount":1552.8,"10th_percentile":1552.8,"90th_percentile":1552.8},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":1732.8,"10th_percentile":1732.8,"90th_percentile":2044.8,"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":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"1 through 10","median_amount":368.22,"10th_percentile":368.22,"90th_percentile":368.22},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"1 through 10","median_amount":446.26,"10th_percentile":446.26,"90th_percentile":686.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"12","median_amount":504.0,"10th_percentile":390.0,"90th_percentile":504.0,"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":"Exchange","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"1 through 10","median_amount":390.0,"10th_percentile":390.0,"90th_percentile":654.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"22","median_amount":22.12,"10th_percentile":22.12,"90th_percentile":23.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","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":17.98,"10th_percentile":17.98,"90th_percentile":17.98,"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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":20.11,"10th_percentile":20.11,"90th_percentile":20.11,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"1 through 10","median_amount":281.22,"10th_percentile":227.55,"90th_percentile":2457.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"1 through 10","median_amount":875.94,"10th_percentile":875.94,"90th_percentile":875.94,"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":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Packaged Services","code_information":[{"code":"N902","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 200% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":60.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Speech Therapy (%BC): 60] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":1616.7,"10th_percentile":1616.7,"90th_percentile":1616.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":82.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1196] [Cardiac Cath ($): 11923] [Lithotripsy ($): 11192] [PTCA ($): 22952] [Observation ($): 6779] [ED Level 1--99281 ($): 503] [ED Level 2--99282 ($): 796] [ED Level 3--99283 ($): 796] [ED Level 4--99284 ($): 2244] [ED Level 5--99285 ($): 2244] [Critical Care ($): 2244] [Cardiac Stress Test ($): 1349] [Other Cardiac Testing ($): 1349] [EEG ($): 1271] [Chemotherapy ($): 5225] [Nuclear Medicine ($): 1940] [Radiation Therapy ($): 5966] [CT Scan OP ($): 1494] [MRI OP ($): 1796] [Imaging Services ($): 670] [Positron Emission Tomography ($): 2091] [Radiology ($): 824] [Ultrasound Imaging ($): 971] [Laboratory ($): 374] [Occupational Therapy ($): 367] [Physical Therapy ($): 367] [Speech Therapy ($): 367] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 2823]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1551] [Cardiac Cath ($): 15488] [Lithotripsy ($): 14521] [PTCA ($): 29040] [Observation ($): 10373] [ED Level 1--99281 ($): 650] [ED Level 2--99282 ($): 879] [ED Level 3--99283 ($): 879] [ED Level 4--99284 ($): 2901] [ED Level 5--99285 ($): 2901] [Critical Care ($): 2901] [Cardiac Stress Test ($): 1742] [Other Cardiac Testing ($): 1742] [EEG ($): 1646] [Chemotherapy ($): 6777] [Nuclear Medicine ($): 2516] [Radiation Therapy ($): 7743] [CT Scan OP ($): 1934] [MRI OP ($): 2324] [Imaging Services ($): 872] [Positron Emission Tomography ($): 2711] [Radiology ($): 1063] [Ultrasound Imaging ($): 1260] [Laboratory ($): 485] [Occupational Therapy ($): 534] [Physical Therapy ($): 534] [Speech Therapy ($): 534] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3680]","count":"0","additional_payer_notes":"No services performed during 15-month 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 ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1355] [Cardiac Cath ($): 13524] [Lithotripsy ($): 12694] [PTCA ($): 26035] [Observation ($): 7689] [ED Level 1--99281 ($): 572] [ED Level 2--99282 ($): 903] [ED Level 3--99283 ($): 903] [ED Level 4--99284 ($): 2543] [ED Level 5--99285 ($): 2543] [Critical Care ($): 2543] [Cardiac Stress Test ($): 1529] [Other Cardiac Testing ($): 1529] [EEG ($): 1441] [Chemotherapy ($): 5926] [Nuclear Medicine ($): 2201] [Radiation Therapy ($): 6769] [CT Scan OP ($): 1694] [MRI OP ($): 2035] [Imaging Services ($): 762] [Positron Emission Tomography ($): 2369] [Radiology ($): 934] [Ultrasound Imaging ($): 1101] [Laboratory ($): 426] [Occupational Therapy ($): 413] [Physical Therapy ($): 413] [Speech Therapy ($): 413] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - 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 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1622] [Cardiac Cath ($): 16246] [Lithotripsy ($): 15231] [PTCA ($): 30264] [Observation ($): 10739] [ED Level 1--99281 ($): 684] [ED Level 2--99282 ($): 907] [ED Level 3--99283 ($): 907] [ED Level 4--99284 ($): 2851] [ED Level 5--99285 ($): 2851] [Critical Care ($): 2851] [Cardiac Stress Test ($): 1823] [Other Cardiac Testing ($): 1823] [EEG ($): 1726] [Chemotherapy ($): 8123] [Nuclear Medicine ($): 2635] [Radiation Therapy ($): 8123] [CT Scan OP ($): 2034] [MRI OP ($): 2443] [Imaging Services ($): 910] [Positron Emission Tomography ($): 2839] [Radiology ($): 1110] [Ultrasound Imaging ($): 1318] [Laboratory ($): 505] [Occupational Therapy ($): 479] [Physical Therapy ($): 479] [Speech Therapy ($): 479] [Other Outpatient Implant (%BC): 60] [IV Therapy ($): 3864]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":34.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 110]","count":"1 through 10","median_amount":206.7,"10th_percentile":206.7,"90th_percentile":206.7,"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":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","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":"PHCS - Multiplan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":125.97,"10th_percentile":122.73,"90th_percentile":125.97,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":33.15,"10th_percentile":32.32,"90th_percentile":33.15,"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":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Observation (%BC): 24] [Emergency Department (%BC): 28 Maximum Reimbursement: 16736] [Urgent Care ($): 231] [All Other OP (%BC): 24]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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 ($): 2943] [Observation ($): 9350] [Emergency Department ($): 2800] [Urgent Care ($): 359] [All Other OP (%BC): 41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% 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","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_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":581.85,"10th_percentile":581.85,"90th_percentile":11638.82,"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":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9378.85,"10th_percentile":9378.85,"90th_percentile":9378.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":12453.5,"10th_percentile":12453.5,"90th_percentile":12453.5,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":496.58,"10th_percentile":496.58,"90th_percentile":496.58,"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":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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","payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"1 through 10","median_amount":160.74,"10th_percentile":160.74,"90th_percentile":160.74,"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":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":4680.76,"10th_percentile":4680.76,"90th_percentile":4680.76,"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":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"1 through 10","median_amount":87.97,"10th_percentile":87.97,"90th_percentile":87.97,"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":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% 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":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 208% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 101487 | Threshold 101487 (% BC): 65] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"NCH","methodology":"percent of total billed charges","standard_charge_percentage":46.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allianz","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":77.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 225% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Choice - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Options - HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 41.54] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Network Blue - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 45.62] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Traditional - PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 248857 | Threshold 248857 (% BC): 49.69] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":51.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"International","methodology":"percent of total billed charges","standard_charge_percentage":67.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 110]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meritain","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":56.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS - Multiplan","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 50000 | Threshold 50000 (% BC): 85] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Health","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicaid Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine","plan_name":"Medicare Managed Care Plan-HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 13 days | Threshold Excess Per Diem: 4322] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"International","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: 20 days | Threshold Excess Per Diem: 5200] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 105% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellmed","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Histotripsy mal hepatcel tis","code_information":[{"code":"0686T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17887.96,"maximum":40247.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35775.92,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17887.96,"additional_payer_notes":"APC"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40247.91,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18245.72,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18066.84,"additional_payer_notes":"APC"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18782.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18603.48,"additional_payer_notes":"APC"}]}]},{"description":"Histotripsy mal renal tissue","code_information":[{"code":"0888T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17887.96,"maximum":40247.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35775.92,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17887.96,"additional_payer_notes":"APC"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40247.91,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18245.72,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18066.84,"additional_payer_notes":"APC"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18782.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18603.48,"additional_payer_notes":"APC"}]}]},{"description":"Pef bronch ablt 3d nav ebus","code_information":[{"code":"C8005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17887.96,"maximum":40247.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35775.92,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17887.96,"additional_payer_notes":"APC"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40247.91,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Medicare Managed 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schedule","standard_charge_dollar":35775.92,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17887.96,"additional_payer_notes":"APC"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40247.91,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18245.72,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18066.84,"additional_payer_notes":"APC"},{"payer_name":"UPMC","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18782.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee 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